Some stories begin with something as simple as upper abdominal pain.

       Late one night, a middle-aged woman arrived at the emergency department, pale and clutching her upper abdomen.

“Doctor, is this just stomachache?” she asked.

     This question is heard countless times in emergency rooms.

But for trauma surgeons, every episode of abdominal pain may signal a very different underlying disease.

After evaluation, she was diagnosed with acute cholecystitis—a common yet potentially serious condition.

Its origin, in fact, often lies in a problem many people carry unknowingly: gallstones.

A Small Gallbladder, A Big Medical Challenge

   The gallbladder is a small sac located beneath the liver, responsible for storing and releasing bile to aid in fat digestion.

     When bile composition becomes imbalanced, gallstones may form.

     Many individuals live with gallstones without symptoms, a condition known as asymptomatic cholelithiasis.

     However, when a stone becomes lodged in the gallbladder outlet and causes obstruction, symptomatic gallstone disease may develop.

    Typical symptoms include severe right upper quadrant or epigastric pain, nausea, vomiting, and sometimes radiation of pain to the back or right shoulder.

     In addition, gallbladder polyps may also be detected incidentally.

Dr. Chang notes:

“If a gallbladder polyp is larger than 1 centimeter, associated with gallstones, or has an irregular shape, surgical removal is recommended due to the potential risk of malignant transformation.”

Three Major Complications of Gallstones

     If left untreated, gallstones may lead to three common and serious complications:

1.      Cholecystitis

Obstruction of bile outflow causes gallbladder inflammation, leading to persistent right upper abdominal pain, fever, and sometimes chills.

2.      Cholangitis

When gallstones migrate into the bile duct and cause obstruction and infection, patients may develop high fever and jaundice. This condition can rapidly progress to sepsis and is potentially life-threatening.

3.      Biliary Pancreatitis

Gallstones lodged at the pancreaticobiliary junction can trigger reflux of pancreatic enzymes, resulting in severe epigastric pain, vomiting, and even shock.

Dr. Chang emphasizes:

“Persistent upper abdominal pain, fever, jaundice, or pain radiating to the back should prompt immediate medical attention. Delaying care may result in emergency surgery or even endanger life.”

From Multi-Port to Single-Port: A Surgical Precision Revolution

Traditionally, gallbladder removal was performed using multi-port laparoscopic surgery, requiring three to four small abdominal incisions. Although far less invasive than open surgery, these incisions can still cause visible scars and postoperative discomfort. In recent years, the Department of Trauma Surgery at Far Eastern Memorial Hospital has introduced Robotic Single-Incision Cholecystectomy using the da Vinci system. This technique requires only a single incision of approximately 2.5 cm at the umbilicus.

Through this single access point, high-definition optics and articulated robotic instruments enter the abdomen to complete the procedure.

Dr. Chang highlights the advantages of single-incision robotic surgery:

l   Nearly invisible scarring (hidden within the umbilical fold)

l   Less postoperative pain and faster recovery

l   Shorter hospital stay and quicker return to daily activities

With a smile, he adds:

“Many patients are out of bed the next day, and some even ask at follow-up, ‘Doctor, did I really have surgery?’”

High-Tech with a Gentle Touch: The da Vinci Robotic System

The robotic system provides up to 10-fold magnified vision and highly flexible wristed instruments, enabling precise maneuvers in confined spaces. Importantly, the robot does not operate autonomously. Every movement is controlled directly by the surgeon at the console, translating human intent into precise action.

“The robotic system enhances the surgeon’s stability and dexterity while improving patient safety,” Dr. Chang explains.

“It does not replace the surgeon—it extends human capability.”

This technology represents a paradigm shift in modern surgery: from merely treating disease to delivering care that balances precision, aesthetics, and quality of life.

A Patient’s Story

The woman who arrived with severe nocturnal epigastric pain was confirmed to have acute cholecystitis. The surgical team initiated the robotic single-incision protocol, completing the procedure smoothly in approximately 90 minutes.

She was able to ambulate and resume oral intake on the same day, and was discharged the following day. At her follow-up visit one month later, she smiled and said,

“Doctor, I can’t even see a scar on my abdomen.”

That moment brought smiles to everyone in the clinic.

Dr. Chang reflects:

“The trust and reassurance our patients feel—that is what we strive to protect. No matter how advanced technology becomes, nothing surpasses the joy of seeing a patient regain health with confidence.”

Conclusion | From Pain to Hope

For patients, an episode of upper abdominal pain may seem like an isolated event.

At Far Eastern Memorial Hospital, we see it as an opportunity—to reduce suffering and restore quality of life.

The transition from multi-port laparoscopy to single-incision robotic surgery marks a technological revolution.

The journey from fear to reassurance reflects the human side of medicine.

“Trauma surgery is not only about saving lives,” Dr. Chang concludes.

“It is also about caring for the details of daily living.

Our goal is not just to treat patients—but to help them truly return to life.”

This is the direction we continue to pursue at Far Eastern Memorial Hospital—

using technology to add warmth to medicine, and expertise to bring health closer to every patient.

Keywords: Upper abdominal pain, gallstones, cholecystitis, gallbladder polyps, biliary pancreatitis, single-incision surgery, da Vinci robotic system, trauma surgery

Figure legends:

A.CT scan showing a 3-cm gallstone filling the gallbladder.

B.  Intraoperative fluorescent cholangiography integrated into the da Vinci system, clearly delineating biliary anatomy to prevent injury.

C.Surgeon console, allowing stable and precise remote control of robotic instruments.

The CT scan showed a 3-centimeter gallstone that completely filled the gallbladder.

Intraoperative bile duct fluorescence imaging, combined with the built-in da Vinci robotic arm, allows for clear visualization of the bile duct structure, preventing injury.

The surgeon's console allows for remote control of a robotic arm to perform surgery using a flexible wrist and stable telescopic technique.