Advancing Surgical Precision: Successful Robotic-Assisted Cholecystectomy and Appendectomy in Jakarta, Indonesia - A Case Report

Abstract

Introduction: Robotic-assisted surgery is becoming increasingly popular in minimally invasive general surgical procedures. Some surgical experts report advantages of robotic-assisted surgery such as higher precision levels, improved visualization, and simulated wrist movements with a wider range of motion. With these advantages, robotic-assisted surgery is considered safe and effective, resulting in outcomes that reduce the risk of conversion to laparoscopy or open surgery. However, cost remains a concern in robotic-assisted surgical procedures. Here, we report the experience of two cases consisting of Cholecystectomy and Appendectomy performed concurrently with gynecological and urological procedures using Robotic-assisted Surgery at a hospital in Jakarta, Indonesia.

Case 1: A 54-year-old male patient presented with complaints of worsening right upper abdominal pain over the past year and underwent a medical check-up revealing multiple cholelithiasis on abdominal ultrasound examination. The patient was overweight (Body Mass Index (BMI): 29.7 kg/m2) and physical examination revealed tenderness in the Right Upper Quadrant Abdomen (Murphy's sign). Laboratory tests showed dyslipidemia. The patient underwent Robotic-assisted cholecystectomy with minimal bleeding (10 ml), intraoperatively revealing inflamed gallbladder (cholecystitis). Histopathological examination was performed on gallbladder tissue. The patient was observed post-operatively for < 24 hours, recovered well with minimal postoperative pain, good bowel activity, adequate intake, and was able to mobilize well.

Case 2: A 44-year-old female patient presented with recurrent symptoms of prolonged menstruation and lower abdominal pain. An MRI examination revealed several findings, including intramural submucosal uterine fibroids, right hydronephrosis, and right hydroureter resulting from pressure exerted by a cystic mass in the right adnexa. Additionally, signs of adhesive bowel were noted. During the operation, adhesions and an inflamed appendix were discovered, leading to robotic-assisted appendectomy. The patient was discharged after 24 hours of post-operative observation with good recovery during the follow-up at the outpatient clinic, reporting no pain and uncomplicated wound healing after two weeks of monitoring.

Conclusion:  The cases we report represent the innovative use of robotic technology for cholecystectomy and appendectomy procedures. Robotic-assisted surgery has shown improved safety and higher efficacy compared to conventional laparoscopic surgery.