Robotic Laparoendoscopic Single Site Urological Surgery: Analysis of 50 Consecutive Cases

Abstract

We present our cumulative experience with robotic laparoendoscopic single site urological surgery at a single institution. Medical records of patients undergoing robotic laparoendoscopic single site procedures between May 2008 and December 2010 were analyzed. The da Vinci® S or Si systems and 3 different multichannel single port devices were used. Demographic, intraoperative and postoperative data were assessed. Overall, 50 patients were scheduled to undergo robotic laparoendoscopic single site urological surgery during the study period, representing 36% of the total patients undergoing laparoendoscopic single site surgery at our institution. Mean ± SD patient age was 60.2 ± 13.6 years. Mean body mass index was 27.0 ± 4.5 kg/m(2). Specifically, 24 patients underwent robotic laparoendoscopic single site renal surgery and the same method was used in 26 patients undergoing pelvic surgery. Mean operative time was 207 ± 74 minutes and mean estimated blood loss was 140 ± 111 ml. Four cases were converted to laparoscopy (2 standard, 2 robotic assisted) and 6 cases required at least 1 additional trocar outside of the single site incision. A rectal injury occurred during radical cystectomy, which was recognized intraoperatively and closed primarily without sequelae. Postoperative complications occurred in 8 cases and 1 was Clavien grade IV. Mean length of hospital stay was 2.9 ± 1.7 days. Our preliminary experience with robotic laparoendoscopic single site surgery has demonstrated feasibility and safety in the realm of urological surgery. Widespread adoption of this new approach will likely require redesign of the robotic system or development of a task specific robotic platform, and should be limited to centers with significant robotic, laparoscopic and laparoendoscopic single site surgery experience.