Tips and Tricks for Adapting to Single Port Robotic Surgery

Abstract

Study Objective Demonstrate ways of successfully navigating inherent limitations to the robotic single port surgical modality in the context of hysterectomy. Design Demonstration of surgical technique. Setting Academic medical center. Patients or Participants Women undergoing robotic single port surgery for benign indications. Interventions Robotic single port surgery using the SP1098 da Vinci SP® Surgical System. Measurements and Main Results The primary challenges with single port surgery are optimizing visualization and instrument mobility. The camera can be moved in a traditional fashion, or be cobra-ed, in which the camera retracts and is lifted above or below the instruments to allow for optimal utilization of space. It is best to keep the instruments as extended into the pelvis as is comfortable to allow the surgeon to engage the elbows of the instruments. Obtaining traction of tissue is limited with the single port robot. Medial traction and cephalad traction along the axis of the trocar is not restricted; however, adequate lateral or anterior traction is more challenging to obtain. The single port trocar accommodates a maximum of three instruments. However, two instruments are sufficient to achieve most surgical goals. If the fourth aperture of the trocar is not in use, a laparoscopic instrument can be inserted by the bedside assistant. Unfortunately, the assistant's mobility is greatly restricted. Movement of any laparoscopic instrument is restricted to the axis of the single port trocar. Conclusion Robotic single port gynecologic surgery is achievable with minimal adjustments to surgical technique. Optimizing visualization and instrument mobility is key for successful use of this surgical modality.