Single-site robotic platform in clinical practice: first cases in the USA.

Abstract

The initial experience with urological robotic interventions performed by using the Da Vinci SP® robotic surgical platform (Intuitive Surgical, Sunnyvale, CA, USA) during the first month (September 28th to October 30th, 2018) after the system was installed at our institution is reported herein. The aim of the study was to determine the feasibility and the safety of major urologic procedures as measured by the rate of conversions and the incidence of perioperative complications. Secondary aims of the study consisted of key perioperative surgical outcomes including operative time, blood loss, and length of stay. Pathology data were reported. Data collection was performed under Institutional Review Board approval (IRB 13-780). A total of 15 patients were treated: five robot-assisted radical prostatectomies (two performed by trans-perineal approach), three transperitoneal robot-assisted partial nephrectomies, three cystectomies with intracorporeal ileal conduit urinary diversion, three ureteral reimplantations (one paired to bladder diverticulectomy and litho-lapaxy) and one pyeloplasty. No intraoperative complications occurred. In six cases, the surgeries were performed according to a pure single-site approach. The mean operative time was slightly longer than the one reported for the respective multi-arm robotic procedures in the published experiences, which can be easily explained by the expected learning curve. One minor and one major complication occurred. A learning curve exists when embarking with this surgery. Further investigations and comparative studies with open and standard multi-ports robotic surgery are awaited.