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Belli et al. Mini-invasive Surg 2020;4:77 I http://dx.doi.org/10.20517/2574-1225.2020.70 Page 11 of 12

needs further evaluation especially in terms of oncologic outcomes, but we did demonstrate the safety and
technical feasibility of the robotic approach for the treatment of selected GBC. With an accurate patient
selection, a low threshold for conversion and a proper surgical technique which includes careful tissue
manipulation, the avoidance of any bile spillage, an adequate locoregional lymphadenectomy and the use of
a protective plastic bag for specimen extraction, similar outcomes as with open surgery can be offered by a
robotic approach. In addition, the use of the robotic platform has the potential to facilitate the surgical
procedure when compared to laparoscopy, speed up the learning curve and maintain the benefits of better
short-term outcomes and rapid recovery associated with minimally invasive surgery.

In conclusion, our study described a standardized step-by-step robotic technique for the surgical treatment
of clinically suspected or incidentally diagnosed GBC and demonstrated the feasibility and the safety of the
robotic approach in this setting. More data and multicentre series are needed to confirm our results and to
assess the oncologic outcomes of the robotic approach.

DECLARATIONS
Acknowledgments
Thanks go to Assunta Zazzaro for her appreciated work and team coordination.

Authors’ contributions
Conception and design: Belli A, Patrone R, Izzo F
Manuscript writing, collection and assembly of data, data analysis and interpretation: Belli A, Patrone R
Provision of study materials or patients, critical revision and final approval of manuscript: Belli A, Patrone R,
Albino V, Leongito M, Piccirillo M, Granata V, Pasta G, Palaia R, Izzo F

Availability of data and materials
Data are stored in a database at Fondazione G. Pascale IRCCS Naples.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The study was approved by the local ethics committee. The informed consent to participate of patients was
obtained.

Consent for publication
The informed consent for publication of patients was obtained.

Copyright
© The Author(s) 2020.

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