Novel Robotic da Vinci Instruments for Laparoendoscopic Single-site Surgery - 20/08/11

Doi : 10.1016/j.urology.2010.06.070

Georges-Pascal Haber ^a, Michael A. White ^a, Riccardo Autorino ^a, Pedro F. Escobar ^b, Matthew D. Kroh ^c, Sricharan Chalikonda ^d, Rakesh Khanna ^a, Sylvain Forest ^a, Bo Yang ^a, Fatih Altunrende ^a, Robert J. Stein ^a, Jihad H. Kaouk ^a,^⁎
^a Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
^b Section of Gynecologic Oncology, Department of OB/GYN and Women's Institute, Cleveland Clinic, Cleveland, OH
^c Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
^d The Department of Hepato-Pancreato-Biliary & Transplant Surgery, Cleveland Clinic, Cleveland, OH

Reprint requests: Jihad H. Kaouk, M.D., Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH 44195

Résumé

Objectives

To describe novel robotic laparoendoscopic single-site surgery (R-LESS) instruments, and present the initial laboratory experience in urology.

Methods

The VeSPA surgical instruments (Intuitive Surgical, Sunnyvale, CA) were designed to be used with the DaVinci Si surgical system. A multichannel port and curved cannulae were inserted through a single 3.5-cm umbilical incision. The port allowed 1 scope, 2 robotic instruments, and a 5- to 12-mm assistant instrument. Four pyeloplasties (right 2, left 2), 4 partial nephrectomies (right 2, left 2), and 8 nephrectomies (right 4, left 4) were performed in 4 female farm pigs (mean weight, 34.5 kg). Technical feasibility and efficiency were assessed in addition to perioperative outcomes.

Results

All 16 R-LESS procedures were performed successfully without the addition of laparoscopic ports or open conversion. Mean total operative time was 110 minutes (range, 82–127), and mean blood loss was 20 mL (range, 10–100). Mean warm ischemia time for partial nephrectomy was 14.8 minutes (range, 12–20). There were no intraoperative complications. No robotic system failures occurred, and robotic instrument clashing was found to be minimal. One needle driver malfunctioned and assistant movement was limited.

Conclusions

R-LESS kidney surgery using the VeSPA instruments is feasible and efficient in the porcine model. The system offers a wide range of motion, instrument and scope stability, improved ergonomics, and minimal instrument clashing. Although preliminary experience is encouraging, further refinements are expected to optimize urological applications of this robotic technology.

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