Robotic laparoendoscopic single-site surgery using GelPort as the access platform.
BACKGROUND
Laparoendoscopic single-site surgery (LESS) allows for the performance of major urologic procedures with a single small incision and minimal scarring. The da Vinci Surgical System provides advantages of easy articulation and improved ergonomics; however, an ideal platform for these procedures has not been identified.


OBJECTIVE
To evaluate the GelPort laparoscopic system as an access platform for robotic LESS (R-LESS) procedures.


METHODS
Since April 2008, 11 R-LESS procedures have been completed successfully in a single institutional referral center. For the last four consecutive cases, the GelPort has been used as an access platform through a 2.5-5-cm umbilical incision.


METHODS
R-LESS cases performed with the GelPort included pyeloplasty (n=2), radical nephrectomy (n=1), and partial nephrectomy (n=1).


METHODS
Perioperative data were obtained for all patients including demographic data, operative indications, operative records, length of stay, complications, and pathologic analysis.


CONCLUSIONS
For both pyeloplasty cases, average operative time (OR time) was 235 min and estimated blood loss (EBL) was 38 cm(3). For the patient undergoing radical nephrectomy for a 5.1-cm renal tumor, OR time was 200 min and EBL was 250 cm(3). The final patient underwent partial nephrectomy without renal hilar clamping for an 11-cm angiomyolipoma with OR time of 180 min and EBL of 600 cm(3). All R-LESS procedures attempted with the GelPort were completed successfully and without complication. Average length of hospital stay was 1.75 d (range: 1-2). The partial nephrectomy patient required transfusion of 1 U of packed red blood cells.


CONCLUSIONS
Use of the GelPort as an access platform for R-LESS procedures provides adequate spacing and flexibility of port placement and acceptable access to the surgical field for the assistant, especially during procedures that require a specimen extraction incision. Additional platform and instrumentation development will likely simplify R-LESS procedures further as experience grows.
Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Robert J
RJ
Stein
Wesley M
WM
White
Raj K
RK
Goel
Brian H
BH
Irwin
George Pascal
GP
Haber
Jihad H
JH
Kaouk
D000328:Adult; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D004867:Equipment Design; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation*; D013048:Specimen Handling / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult