title: Robotic single-site kidney surgery: evaluation of second-generation instruments in a cadaver model.
abstract: OBJECTIVE
  To evaluate the second generation of single-site instruments for robotic laparoendoscopic single-site surgery (R-LESS) for kidney procedures in a cadaver model.
  
  
  METHODS
  Three procedures, including 1 pyeloplasty, 1 partial nephrectomy, and 1 nephrectomy, were conducted in a female cadaver model. A da Vinci Si system (Intuitive Surgical, Sunnyvale, CA) and the second generation of single-site instruments, specifically designed for R-LESS, were used.
  
  
  RESULTS
  All the procedures were completed successfully without the addition of extra ports. Time to set up the port and instruments was 40 minutes. In the pyeloplasty, time to complete the anastomosis was 39 minutes. In the partial nephrectomy, simulated ischemia time was 21 minutes. In the nephrectomy, time to complete the resection was 13 minutes. No significant gas leak was noticed during the procedures. There were no injuries to intraabdominal organs or vessels.
  
  
  CONCLUSIONS
  Robotic single-site renal surgery using a second generation of specifically designed instruments was feasible in a cadaver model, obviating many limitations of LESS. Lack of articulation at the tip of the instruments represents the main disadvantage of this novel instrumentation, especially in case of reconstructive procedures.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. kaoukj@ccf.org
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Rachid
authors.initials: R
authors.lastname: Yakoubi
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kassab
authors.forename: Emad
authors.initials: E
authors.lastname: Rizkala
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation*; D009392:Nephrectomy; D012371:Robotics / Q000295:instrumentation*; D013997:Time Factors