title: First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform.
abstract: BACKGROUND
  Interest in single-incision laparoscopic techniques continues to grow. A learning curve certainly exists, and although the techniques have improved, technical considerations including external clashes, poor visualization of critical structures, and surgeon fatigue remain. Applications of robotics to these newer techniques are evolving. The da Vinci Single-Site robotic surgery platform is a new semi-rigid robotic operative system designed to work with the Intuitive Surgical da Vinci Si operative system. The authors present the first human experience with this new device used to perform single-incision laparoscopic cholecystectomy. This study aimed to present the first human experience performing cholecystectomy with a novel robotic single-port platform.
  
  
  METHODS
  After Cleveland Clinic Institutional Review Board approval, patients with symptomatic biliary disease fitting standard criteria for cholecystectomy were enrolled in the study. A total of 13 consecutive single-port, robotic cholecystectomy operations were performed. Patient demographics and operative results were evaluated.
  
  
  RESULTS
  All 13 operations were completed successfully with the Single-Site platform. A critical view of safety as determined by the operative surgeon was obtained in all cases. One patient required placement of an additional extra-umbilical trocar for appropriate visualization secondary to gallbladder necrosis, and this incision also was used for eventual drain placement. For two patients, an intraoperative choloangiogram was performed. The mean operative time was 107 ± 54 min, and the mean docking time was 15 ± 9 min. Discharge for 11 patients was within 24 h. No significant complications occurred.
  
  
  CONCLUSIONS
  Cholecystectomy using the da Vinci Single-Site system is feasible. Availability of this new semi-rigid, robotic surgery platform may increase access to the potential advantages of single-site surgery. Additional advantages of single-site surgery may be elucidated with further studies.
authors.affiliation: Cleveland Clinic, Digestive Disease Institute, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA. krohm@ccf.org
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Kevin
authors.initials: K
authors.lastname: El-Hayek
authors.forename: Steven
authors.initials: S
authors.lastname: Rosenblatt
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
authors.forename: Pedro
authors.initials: P
authors.lastname: Escobar
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult