Robotic Laparoendoscopic Single-Site Surgery Using GelPort as the Access Platform

Abstract

BackgroundLaparoendoscopic single-site surgery (LESS) allows for the performance of major urologic procedures with a single small incision and minimal scarring. The da Vinci Surgical System provides advantages of easy articulation and improved ergonomics; however, an ideal platform for these procedures has not been identified. ObjectiveTo evaluate the GelPort laparoscopic system as an access platform for robotic LESS (R-LESS) procedures. Design, setting, and participantsSince April 2008, 11 R-LESS procedures have been completed successfully in a single institutional referral center. For the last four consecutive cases, the GelPort has been used as an access platform through a 2.5–5-cm umbilical incision. InterventionR-LESS cases performed with the GelPort included pyeloplasty (n=2), radical nephrectomy (n=1), and partial nephrectomy (n=1). MeasurementsPerioperative data were obtained for all patients including demographic data, operative indications, operative records, length of stay, complications, and pathologic analysis. Results and limitationsFor both pyeloplasty cases, average operative time (OR time) was 235min and estimated blood loss (EBL) was 38cm3. For the patient undergoing radical nephrectomy for a 5.1-cm renal tumor, OR time was 200min and EBL was 250cm3. The final patient underwent partial nephrectomy without renal hilar clamping for an 11-cm angiomyolipoma with OR time of 180min and EBL of 600cm3. All R-LESS procedures attempted with the GelPort were completed successfully and without complication. Average length of hospital stay was 1.75 d (range: 1–2). The partial nephrectomy patient required transfusion of 1 U of packed red blood cells. ConclusionsUse of the GelPort as an access platform for R-LESS procedures provides adequate spacing and flexibility of port placement and acceptable access to the surgical field for the assistant, especially during procedures that require a specimen extraction incision. Additional platform and instrumentation development will likely simplify R-LESS procedures further as experience grows.