title: da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access.
abstract: OBJECTIVE
  Minimally invasive surgery including laparoscopic and robotic surgery was recently approved for clinical use in hepatobiliary surgery. The purpose of this article is to evaluate the feasibility and technical aspects of robotic single incision for hepatobiliary surgery using the GelPort laparoscopic system in a preliminary animal study.
  
  
  METHODS
  We performed eight robotic single-incision laparoscopic surgery (SILS) procedures, including four cholecystectomies and four lateral segmentectomy of the liver, in a porcine study using the da Vinci S-HD Surgical System. A single-channel GelPort access was placed through a 2.5-cm single incision for robotic access. A 12-mm camera port, two 8-mm ports for the robotic arms and one 5-mm port for the patient-side assistant were inserted. A Mini Loop Retractor was applied to retract the fundus of the gallbladder. The EndoWrist dissector and grasping forceps was introduced to fine-dissect Calot's triangle. The instruments were crossed to avoid "sword fighting" and clashing of instruments in the abdomen. The cystic duct was divided after double ligation and the gallbladder was removed. Hepatic transection was performed with bipolar Harmonic shears and LigaSure for vascular pedicles.
  
  
  RESULTS
  All robotic SILS procedures were completed (8/8, 100%). The cholecystectomies and hepatectomies were safely performed in average operating times of 70 min (±15) and 60 min (±20), respectively, with minimal blood loss. There were no conversions, re-interventions or extension of the skin incision.
  
  
  CONCLUSIONS
  Robotic hepatobiliary SILS is technically feasible and safe using GelPort as a single-incision access platform. Robotic SILS is becoming established and is enormously advantageous to the patient.
authors.affiliation: Department of Gastroenterology, Kobe University Graduate School of Medicine, National University Corporation, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. sgmt@med.kobe-u.ac.jp
authors.forename: Maki
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Mari
authors.initials: M
authors.lastname: Man-i
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shoko
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D004195:Disease Models, Animal; D004867:Equipment Design; D005705:Gallbladder Diseases / Q000601:surgery*; D006498:Hepatectomy / Q000295:instrumentation*; D020706:Laparoscopes; D008107:Liver Diseases / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation*; D013552:Swine; D016896:Treatment Outcome