Robotic single-incision transabdominal and transvaginal surgery: initial experience with intersecting robotic arms.
BACKGROUND
Single-incision laparoscopic and natural orifice translumenal endoscopic surgery (NOTES) are technically challenging methods. Robotics might have the potential to overcome such hurdles with computer technology.


METHODS
The da Vinci Standard and S System (Intuitive, Sunnyvale, USA) were used in human cadavers and pigs to perform single-incision transabdominal and transvaginal surgery. Robotic arms were crossed and control-switched to achieve intuitive control.


RESULTS
It was possible to perform robotic single-incision laparoscopy in the typical, intuitive fashion. Transvaginal set-up, including docking of the system and introduction of instruments into the abdominal cavity, was possible but no useful manipulation could be performed.


CONCLUSIONS
While robotic NOTES with the da Vinci surgical system was not successful, robotic single-incision surgery is feasible using the above set-up. This new approach seems to offer the advantages of single-incision surgery while maintaining the intuitive control of robotic surgery. Clinical application appears justified.
Hagen
Monika E
ME
Center for the Future of Surgery, Department of Surgery, University of California at San Diego, CA 92108, USA. MonikaHagen@aol.com
Wagner
Oliver J
OJ
Inan
Ihsan
I
Morel
Philippe
P
Fasel
Jean
J
Jacobsen
Garth
G
Spivack
Adam
A
Thompson
Kari
K
Wong
Brian
B
Fischer
Lauren
L
Talamini
Mark
M
Horgan
Santiago
S
D000005:Abdomen / Q000601:surgery*; D002102:Cadaver; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D014621:Vagina / Q000601:surgery*