title: Novel robotic da Vinci instruments for laparoendoscopic single-site surgery.
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Escobar
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kroh
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Sylvain
authors.initials: S
authors.lastname: Forest
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunrende
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D012371:Robotics / Q000295:instrumentation*; D034421:Sus scrofa; D013552:Swine; D013997:Time Factors; D052096:Warm Ischemia