You have accessJournal of UrologySingle Port Surgery1 Apr 2012V2158 ROBOTIC SINGLE SITE KIDNEY SURGERY: EARLY EXPERIENCE IN A CADAVER MODEL WITH NOVEL PURPOSE-BUILT INSTRUMENTS Riccardo Autorino, Humberto K. Laydner, Shahab Hillyer, Rachid Yakoubi, Ahmad Kassab, Wahib Isaac, Emad Rizkala, Georges-Pascal Haber, Robert J. Stein, and Jihad H. Kaouk Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Humberto K. LaydnerHumberto K. Laydner Cleveland, OH More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Rachid YakoubiRachid Yakoubi Cleveland, OH More articles by this author , Ahmad KassabAhmad Kassab Cleveland, OH More articles by this author , Wahib IsaacWahib Isaac Cleveland, OH More articles by this author , Emad RizkalaEmad Rizkala Cleveland, OH More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , Robert J. SteinRobert J. Stein Cleveland, OH More articles by this author , and Jihad H. KaoukJihad H. Kaouk Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2330AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A novel set of robotic instruments - termed the da Vinci Single-Site instruments - has been developed specifically for robot assisted single-site laparoscopy. We first described their use in a porcine model. More recently, clinical cholecystectomy series have been reported. Herein, we describe a second generation of instruments for robotic single-site surgery and report our early experience in a cadaver model for kidney procedures. METHODS Three types of kidney procedures (ie pyeloplasty, partial nephrectomy & nephrectomy) were performed in a female cadaver using a da Vinci Si™ system in a 3-arm configuration and a set of novel instruments specifically designed for urologic and gynecologic procedures. The sets includes: a multichannel port allowing the placement of an 8.5-mm scope, a 12-mm assistant port, and 2 crossing curved cannulae for the robotic instruments. These cannualae are shorter than the already described version as they are specifically designed for urologic and gynecologic single site surgery. Instruments feature a semirigid shaft allowing them to be inserted through the cannulae, but they do not have a wrist at the distal tip. The multichannel port was inserted through a 2.5 cm transumbilical incision. A lower abdominal standard port was also inserted but only used for video recording purposes RESULTS Time to setup was 40 minutes. No significant gas leak was observed. Three left side procedures successfully completed without addition of extra ports in 4 hours. Suturing time for pyeloplasty was 39 min. Ischemia time for partial nephrectomy was 21 min. Lack of wrist at instrument tip affected suturing tasks and previous laparoscopic experience is needed. Limited range of motion was noted by the console surgeon at the edges. Instrument exchange was easy. Suboptimal retraction and suction by the assistant was due to collision/unfavorable working angle and limited external working space. CONCLUSIONS The feasibility of a variety of robotic kidney procedures by using a 2nd generation of instruments specifically designed for da Vinci™ single-site surgery has been demonstrated in a cadaver model. Advantages of this system compared with conventional LESS include increased dexterity, instrument and scope stability, better ergonomics, and decreased instrument clashing. Limitations have been observed, including lack of articulated instruments and difficulty for the bedside assistant due to limited working space © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e871 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Autorino Cleveland, OH More articles by this author Humberto K. Laydner Cleveland, OH More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Rachid Yakoubi Cleveland, OH More articles by this author Ahmad Kassab Cleveland, OH More articles by this author Wahib Isaac Cleveland, OH More articles by this author Emad Rizkala Cleveland, OH More articles by this author Georges-Pascal Haber Cleveland, OH More articles by this author Robert J. Stein Cleveland, OH More articles by this author Jihad H. Kaouk Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...