title: SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application.
abstract: This case study describes our initial laboratory experience using the SPIDER surgical system (TransEnterix, Morrisville, NC, USA) for laparoendoscopic single-site surgery (LESS) urologic procedures and reports its first clinical application. The SPIDER system was tested in a laboratory setting and used for a clinical case of renal cyst decortication. Three tasks were performed during the dry lab session, and different urologic procedures were conducted in a porcine model. The time to complete the tasks and penalties were registered during the dry lab session. Perioperative outcomes and subjective assessment by the surgeons were registered. The surgeons had a positive experience with the SPIDER system, with a mean overall score of 3.6 (on a scale of 1-5). The surgeons were able to gain proficiency in performing tasks regardless of their level of expertise. The highest scores recorded were for ease of device insertion, instrument insertion and exchange, and triangulation. The lowest scores were for retraction. During the clinical case, the platform provided good triangulation without instrument clashing. However, retraction was challenging because of the lack of strength and precise maneuverability with the tip of the instruments fully deployed. The SPIDER system offers intuitive instrument maneuverability and restored triangulation without external instrument clashing. Further refinements are awaited to define its role in the urologic LESS armamentarium.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. haberg2@ccf.org
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunrende
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Gregory
authors.initials: G
authors.lastname: Spana
authors.forename: Isac
authors.initials: I
authors.lastname: Wahib
authors.forename: Khaled
authors.initials: K
authors.lastname: Fareed
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000601:surgery; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation; D013552:Swine; D013520:Urologic Surgical Procedures / Q000295:instrumentation*