Novel robotic da Vinci instruments for laparoendoscopic single-site surgery.
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.
Haber
Georges-Pascal
GP
Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
White
Michael A
MA
Autorino
Riccardo
R
Escobar
Pedro F
PF
Kroh
Matthew D
MD
Chalikonda
Sricharan
S
Khanna
Rakesh
R
Forest
Sylvain
S
Yang
Bo
B
Altunrende
Fatih
F
Stein
Robert J
RJ
Kaouk
Jihad H
JH
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