title: Robotic single-port transumbilical surgery in humans: initial report.
abstract: OBJECTIVE
  To describe our initial clinical experience of robotic single-port (RSP) surgery.
  
  
  METHODS
  The da Vinci S robot (Intuitive, Sunnyvale, CA, USA) was used to perform radical prostatectomy (RP), dismembered pyeloplasty, and radical nephrectomy. A robot 12-mm scope and 5-mm robotic grasper were introduced through a multichannel single port (R-port, Advanced Surgical Concepts, Dublin, Ireland). An additional 5-mm or 8-mm robotic port was introduced through the same umbilical incision (2 cm) alongside the multichannel port and used to introduce robotic instruments. Vesico-urethral anastomosis and pelvi-ureteric anastomosis were successfully performed robotically using running intracorporeal suturing.
  
  
  RESULTS
  All three RSP surgeries were performed through the single incision without adding extra umbilical ports or 2-mm instruments. For RP, the operative duration was 5 h and the estimated blood loss was 250 mL. The hospital stay was 36 h and the margins of resection were negative. For pyeloplasty, the operative duration was 4.5 h, and the hospital stay was 50 h. Right radical nephrectomy for a 5.5-cm renal cell carcinoma was performed in 2.5 h and the hospital stay was 48 h. The specimen was extracted intact within an entrapment bag through the umbilical incision. There were no intraoperative or postoperative complications. At 1 week after surgery, all patients had minimal pain with a visual analogue score of 0/10.
  
  
  CONCLUSIONS
  Technical challenges of single-port surgery that may limit its widespread acceptance can be addressed by using robotic technology. Articulation of robotic instruments may render obsolete the long-held laparoscopic principles of triangulation especially for intracorporeal suturing. We report the initial series of robotic surgery through a single transumbilical incision.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. kaoukj@ccf.org
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Raj K
authors.initials: RK
authors.lastname: Goel
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Sebastien
authors.initials: S
authors.lastname: Crouzet
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014472:Umbilicus; D014517:Ureteral Obstruction / Q000601:surgery*