title: Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique.
abstract: OBJECTIVE
  Multiple reports suggest that laparoendoscopic single-site surgery is technically feasible, safe, and effective in treating a variety of gynecological disease processes. The study purpose was to assess the feasibility and safety of a novel robotic single-site platform (R-LESS) for the surgical treatment of benign and malignant gynecological conditions.
  
  
  METHODS
  A single-institution, prospective analysis of 40 women treated with R-LESS on the gynecology and gynecological oncology services from June 2013 through March 2014. Women undergoing hysterectomy or adnexal surgery for either a benign or malignant gynecological condition were offered robotic single-site surgery during the study period of June 1, 2013, through April 1, 2014. Patients underwent surgery through a single 2.5-3.0 cm umbilical incision with a multichannel port and utilizing the da Vinci robotic single-site platform. Two surgeons with extensive laparoendoscopic single-site experience participated.
  
  
  RESULTS
  Forty patients had R-LESS performed. Procedures included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, salpingo-oophorectomy, ovarian cystectomy, excision of endometriosis, and a combined case of total laparoscopic hysterectomy and cholecystectomy. Median age and body mass index were 42 years and 28.2 kg/m(2), respectively. Median operating time, defined as the interval between incision start to closure, was 134 minutes (range, 84-311 minutes). Median vaginal cuff closure was 21 minutes (range, 9-77 minutes). Overall, there appeared to be a linear relationship between vaginal cuff closure time, console time, and operating time with number of cases performed. Procedures were successfully performed via R-LESS in 92.5% of cases; 2 cases required 1 additional port and there was 1 conversion to traditional multiport robotic surgery. There was 1 major postoperative complication (2.5%) and 1 readmission (2.5%). After a median follow-up period of 230 days (range, 61-256), there have been no postoperative hernias diagnosed.
  
  
  CONCLUSIONS
  We present one of the first series of robotic laparoendoscopic single-site surgery for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, R-LESS is feasible and safe in select patients. Further studies are needed to better define the ideal gynecological procedures to perform using robotic single-site surgery and to assess the benefits and costs of R-LESS compared with multiport robotic and conventional laparoscopic approaches.
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD. Electronic address: sscheib1@jhmi.edu.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Scheib
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Fader
mesh_terms: D000328:Adult; D000368:Aged; D004715:Endometriosis / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D010048:Ovarian Cysts / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D058994:Salpingectomy / Q000379:methods; D014592:Uterine Hemorrhage / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery; D055815:Young Adult
keywords: laparoendoscopic single-site surgery; robotic surgery; single-port surgery