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First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform

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Abstract

Background

Interest in single-incision laparoscopic techniques continues to grow. A learning curve certainly exists, and although the techniques have improved, technical considerations including external clashes, poor visualization of critical structures, and surgeon fatigue remain. Applications of robotics to these newer techniques are evolving. The da Vinci Single-Site robotic surgery platform is a new semi-rigid robotic operative system designed to work with the Intuitive Surgical da Vinci Si operative system. The authors present the first human experience with this new device used to perform single-incision laparoscopic cholecystectomy. This study aimed to present the first human experience performing cholecystectomy with a novel robotic single-port platform.

Methods

After Cleveland Clinic Institutional Review Board approval, patients with symptomatic biliary disease fitting standard criteria for cholecystectomy were enrolled in the study. A total of 13 consecutive single-port, robotic cholecystectomy operations were performed. Patient demographics and operative results were evaluated.

Results

All 13 operations were completed successfully with the Single-Site platform. A critical view of safety as determined by the operative surgeon was obtained in all cases. One patient required placement of an additional extra-umbilical trocar for appropriate visualization secondary to gallbladder necrosis, and this incision also was used for eventual drain placement. For two patients, an intraoperative choloangiogram was performed. The mean operative time was 107 ± 54 min, and the mean docking time was 15 ± 9 min. Discharge for 11 patients was within 24 h. No significant complications occurred.

Conclusion

Cholecystectomy using the da Vinci Single-Site system is feasible. Availability of this new semi-rigid, robotic surgery platform may increase access to the potential advantages of single-site surgery. Additional advantages of single-site surgery may be elucidated with further studies.

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References

  1. Rivas H, Varela E, Scott D (2010) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24:1403–1412

    Article  PubMed  Google Scholar 

  2. Curcillo PG II et al (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860

    Article  PubMed  Google Scholar 

  3. Raman SR et al (2011) Does transumbilical single incision laparoscopic adjustable gastric banding result in decreased pain medicine use? A case-matched study. Surg Obes Relat Dis 7(2):129–133

    Article  PubMed  Google Scholar 

  4. Chow A et al (2010) Single-incision laparoscopic surgery for cholecystectomy: a retrospective comparison with 4-port laparoscopic cholecystectomy. Arch Surg 145:1187–1191

    Article  PubMed  Google Scholar 

  5. Chamberlain RS, Sakpal SV (2009) A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg 13:1733–1740

    Article  PubMed  Google Scholar 

  6. Joseph RA et al (2009) “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc 24:1331–1335

    Article  PubMed  Google Scholar 

  7. Kaouk JH et al (2009) Robotic single-port transumbilical surgery in humans: initial report. BJU Int 103:366–369

    Article  PubMed  Google Scholar 

  8. Haber GP et al (2010) Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology 76:1279–1282

    Article  PubMed  Google Scholar 

  9. Escobar PF et al (2009) Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. J Minim Invasive Gynecol 16:589–591

    Article  PubMed  Google Scholar 

  10. Navarra G et al (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

    Article  PubMed  CAS  Google Scholar 

  11. Elsey JK, Feliciano DV (2010) Initial experience with single-incision laparoscopic cholecystectomy. J Am Coll Surg 210:624–626

    Article  Google Scholar 

  12. Philipp SR, Miedema BW, Thaler K (2009) Single-incision laparoscopic cholecystectomy using conventional instruments: early experience in comparison with the gold standard. J Am Coll Surg 209:632–637

    Article  PubMed  Google Scholar 

  13. Hodgett SE et al (2009) Laparoendoscopic single-site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192

    Article  PubMed  Google Scholar 

  14. Nguyen NT et al (2009) A single-port technique for laparoscopic extended stapled appendectomy. Surg Innov 16:78–81

    Article  PubMed  Google Scholar 

  15. Nguyen NT et al (2008) Single laparoscopic incision transabdominal (SLIT) surgery—adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631

    Article  PubMed  Google Scholar 

  16. Reavis KM et al (2008) Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg 18:1492–1494

    Article  PubMed  Google Scholar 

  17. Geisler DP, Condon ET, Remzi FH (2010) Single-incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12:941–943

    Article  PubMed  CAS  Google Scholar 

  18. Stein RJ et al (2010) Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol 57:132–136

    Article  PubMed  Google Scholar 

  19. Kroh M, Rosenblatt S (2009) Single-port, laparoscopic cholecystectomy and inguinal hernia repair: first clinical report of a new device. J Laparoendosc Adv Surg Tech A 19:215–217

    Article  PubMed  Google Scholar 

  20. Jacob BP et al (2009) Single-incision total extraperitoneal (one SITE) laparoscopic inguinal hernia repair using a single-access port device. Hernia 13:571–572

    Article  PubMed  CAS  Google Scholar 

  21. Filipovic-Cugura J et al (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23:920–921

    Article  PubMed  Google Scholar 

  22. Vidal O et al (2009) Laparoendoscopic single-site cholecystectomy: a safe and reproducible alternative. J Laparoendosc Adv Surg Tech A 19:599–602

    Article  PubMed  Google Scholar 

  23. Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168

    Article  PubMed  CAS  Google Scholar 

  24. Tantia O et al (2008) Iatrogenic biliary injury: 13, 305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg Endosc 22:1077–1086

    Article  PubMed  CAS  Google Scholar 

  25. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125

    PubMed  CAS  Google Scholar 

  26. Kravetz AJ et al (2009) The learning curve with single-port cholecystectomy. JSLS 13:332–336

    PubMed  Google Scholar 

  27. Chiruvella A et al (2010) Iatrogenic combined bile duct and right hepatic artery injury during single-incision laparoscopic cholecystectomy. JSLS 14:268–271

    Article  PubMed  Google Scholar 

  28. Walsh M. Personal communication

  29. Rawlings A et al (2010) Single-incision laparoscopic cholecystectomy: initial experience with critical view of safety dissection and routine intraoperative cholangiography. J Am Coll Surg 211:1–7

    Article  PubMed  Google Scholar 

  30. White MA et al (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58:544–550

    Article  PubMed  Google Scholar 

  31. Ciulla A et al (2006) Gallbladder carcinoma late metastases and incisional hernia at umbilical port site after laparoscopic cholecystectomy. G Chir 27:214–216

    PubMed  CAS  Google Scholar 

  32. Rice DC et al (1997) Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J Gastrointest Surg 1:85–90 discussion 90–91

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Matthew Kroh, Pedro Escobar, Jihad Kaouk, and Sricharan Chalikonda serve as consultants for Intuitive Surgical, Sunnyvale, CA, USA. Kevin El-Hayek, Steven Rosenblatt, and Bipan Chand have no conflicts of interest or financial ties to disclose.

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Correspondence to Matthew Kroh.

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Kroh, M., El-Hayek, K., Rosenblatt, S. et al. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc 25, 3566–3573 (2011). https://doi.org/10.1007/s00464-011-1759-1

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  • DOI: https://doi.org/10.1007/s00464-011-1759-1

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