Robotic Single-port Research Articles

Single-Port Versus Multi-Port Robotic Retroperitoneal Partial Nephrectomy: A Propensity Score-Matched Comparison.

Objective: To compare the surgical results of retroperitoneal (RP) robot partial nephrectomy (PNx) using either a single-port robot (SP) or a multi-port robot (MP). Materials and Methods: We retrospectively reviewed all RP robotic PNx performed at a single institution from September 2021-when the SP robot was introduced to the institution-through April 2023. In total, 125 patients underwent the surgery; 81 patients were treated with surgery using a MP robot whereas 44 patients were treated with surgery using a SP. All MP surgeries were performed with da Vinci Xi (Intuitive, Sunnyvale, California, USA), while all SP surgeries were performed with da Vinci SP (Intuitive, Sunnyvale, California, USA). We performed a propensity score-matching (PSM) analysis of these 125 patients. Results: There was no significant difference between the two groups after PSM. In terms of operation time, that for MP was 103.68 ± 21.89 minutes whereas that for SP was 95.43 ± 32.22 minutes (p-value = 0.164). Meanwhile, in terms of console time, that for MP was 70.95 ± 21.92 minutes whereas that for SP was 64.14 ± 32.06 minutes (p-value = 0.248). In terms of estimated blood loss was 90.91 ± 91.06 mL in MP and 92.27 ± 104.30 mL in SP (p-value = 0.948). Lastly, there was a statistically significant difference in warm ischemic time, as it was 17.18 ± 6.56 minutes in MP and 13.82 ± 4.59 in SP (p-value = 0.007). There were no statistically significant differences between MP and SP in any other surgical outcomes. Conclusions: SP robot RP PNx demonstrated comparable outcomes to those achieve using MP procedures. This means SP robot RP PNx can be considered a preferable and more convenient surgical approach than conventional methods, particularly when dealing with small renal masses located in the posterior side of the kidney.

Exploring the Potential of Robotic Single-Port Surgery for Gallbladder Cancer: Initial Insights and Future Prospects.

Robotic surgery has demonstrated outcomes comparable or superior to open and laparoscopic surgeries for extended cholecystectomy.1-8 Despite its advantages, the minimally invasive robotic single-port (SP) system remains underutilized in complex hepatobiliary pancreatic surgery due to instrument limitations and retraction issues.9,10 This study evaluated the feasibility, safety, and effectiveness of the da Vinci SP system in gallbladder cancer surgery. The study was approved by the Ethics Committee of OOO University Hospital (IRB no. DAUH IRB-24-081) and conducted in accordance with the principles of the Declaration of Helsinki. The requirement for informed consent was waived due to the study's retrospective design. A 62-year-old woman with a diagnosis of gallbladder cancer was referred for surgery. Preoperative computed tomography (CT) scans showed no evidence of metastasis (T2N0). Therefore, a robotic SP extended cholecystectomy was planned. Figure 1 shows a 30-mm SP port and a 1-mm assistant port inserted for the procedure. Due to the absence of an energy device for the liver wedge resection, Maryland bipolar forceps were used, mimicking the Kelly clamp crushing technique. A monopolar cautery hook was used for lymph node resection of stations 7, 8, 12, and 13 (Fig. 2). Fig. 1 Port placement for robotic extended cholecystectomy using the da Vinci Xi system Fig. 2 Demonstration of full lymph node dissection RESULTS: The total duration of the operation was 226 min, with an estimated blood loss of 200 ml. The CT scan on day 5 showed no abnormalities, and the patient was discharged routinely on day 7 (Fig. 3). The pathologic examination confirmed adenocarcinoma (T2a) with clear resection, and all six lymph nodes tested negative for malignancy. Fig. 3 The wound 2 weeks after surgery CONCLUSIONS: This study underscores the adequacy of robotic surgeries and emphasizes the potential of the da Vinci SP system in hepatobiliary surgery. Despite current challenges related to instrument limitations, the authors are confident that the SP system will evolve into a crucial asset for hepatobiliary surgical practices in the foreseeable future.

Single-port extra-peritoneal robotic radical prostatectomy in a patient with hostile abdomen

ABSTRACT This video explores the technique and outcomes of robotic radical prostatectomy (RP) using the da Vinci single-port robot in a 42-year-old obese male with localized intermediate-risk prostate cancer and a prior history of extensive abdominal surgeries. The patient was placed in a supine position, with minimal Trendelenburg, and an extraperitoneal approach was taken, the abdominal cavity was not entered, and standardized steps of robotic RP were executed. The surgery lasted 190 min and the blood loss was 100 mL. The patient was discharged on the postoperative day 1, and the prostate-specific antigen was undetectable after 6 months and he had excellent functional outcomes.

Robotic single-port plus one-port splenic vessel-conserving spleen-preserving distal pancreatectomy: a case report.

Minimally invasive distal pancreatectomy is a safe and effective surgical approach for the treatment of distal pancreatic tumors. Recently, the da Vinci single-port (SP) system (Intuitive Surgical, Inc.) was introduced to overcome the previously known limitations of this approach. Here, we report our experience with robotic SP plus one-port splenic vessel-conserving spleen-preserving distal pancreatectomy (RSP + 1 SVc-SpDP). A 38-year-old male patient was incidentally found to have a pancreatic neuroendocrine tumor. On May 12, 2023, RSP + 1 SVc-SpDP was performed. The robotic SP was placed at the transumbilical site, and an additional 12-mm port was placed on the left side of the patient's abdomen. The surgical procedure was based on splenic vessel-conserving, spleen-preserving distal pancreatectomy. The operative time was 350 minutes, and the patient was discharged on postoperative day 8 without any complications. The initial experience of RSP + 1 SVc-SpDP using the da Vinci SP system showed the possibility of an alternative operation for distal pancreatectomy.

Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES(RSP-vNOTES) Hysterectomy: A Case Series

ObjectiveTo demonstrate the feasibility and short-term outcomes of Robot-Assisted Single Port vaginal NOTES (RSP-vNOTES) for total hysterectomy, with or without endometriosis resection for all stages. DesignRetrospective case series. SettingSingle academic tertiary care hospital in Houston, Texas, USA. Participants28 adult women with chronic pelvic pain who underwent RSP-vNOTES hysterectomy, with or without endometriosis resection. InterventionsHysterectomy with or without excision of endometriosis via single-port robot-assisted vNOTES platform (Intuitive Da Vinci SP Platform). Main Results28 patients with a mean age of 40.1 years (range 24.0-54.0 years), mean BMI 28.5 kg/m2 (range 19.5-48.4 kg/m2), underwent RSP-vNOTES from November 11, 2023 to May 7, 2024. Five (17.9%) patients underwent solely a hysterectomy, while 23 (82.1%) patients underwent additional endometriosis resection; 28.6% with stage I, 25.0% stage II, 7.1% stage III, and 21.4% with stage IV. Mean total operative time was 188.7 minutes (range 135.0-427.0 minutes), with robot dock time of 2.9 minutes (range 1.0-10.0 minutes), robot console time of 97.3 minutes (range 51.0-221.0 minutes), and hysterectomy time of 55.3 minutes (range 24.0-170.0 minutes). Estimated blood loss averaged 32.1 mL (range 25.0-50.0mL). One case required a mini-laparotomy as the irregularly-shaped 1668g fibroid uterus was unable to be removed vaginally. Complications included one case of vaginal cuff cellulitis and one case of urinary tract infection. ConclusionOur findings indicate that RSP-vNOTES, a novel single-port surgical approach, presents a promising alternative surgical platform in vaginal surgeries.

Initial case series experience with robotic-assisted transanal minimally invasive surgery performed with da Vinci single-port system for the excision of rectal cancer.

Transanal minimally invasive surgery (TAMIS) is widely used for rectal lesion excision. Robot-assisted TA TAMIS (R-TAMIS) may improve surgical ergonomics. The introduction of the da Vinci Single-Port (SP) robot, designed for endoluminal surgery, has brought new possibilities. Our primary objective herein was to assess the technical and oncological feasibility and efficacy of Single-port robotic TAMIS (SPR-TAMIS) in rectal cancer excision. The secondary objective was to analyze the perioperative outcomes. We included 14 consecutive patients with rectal cancer who underwent SPR-TAMIS between April 2021 and February 2023. Patient data, surgical details, and clinical outcome data were collected to assess the safety and feasibility of SPR-TAMIS. The median participant age was 72years, and full-thickness excision was performed without specimen fragmentation in all cases. The median tumor diameter was 2.7cm, positioned between 10cm proximally and 7cm distally from the anal verge. Negative margins were achieved in 93% of cases, with one case requiring further resection. The median operative time was 175min, and the median hospital stay was 5days. No intraoperative conversion from SPR-TAMIS to laparoscopic or conventional transanal excision was required. No mortalities or major postoperative complications occurred; however, one patient (7.1%) experienced minor morbidity manifesting as wound dehiscence (Clavien-Dindo grade I). No recurrence was observed during the 24-month follow-up. In our early experience, SPR-TAMIS is a safe and feasible surgery for selected early stage rectal cancers, offering enhanced visualization and stable maneuverability transanally. This platform may have potential advantages for the excision of larger or more proximal lesions.

Learning Curve Analysis of Single-Incision Ovarian Cystectomy: Comparative Study of Robotic and Conventional Laparoscopic Techniques.

Ovarian cystectomy, aimed at preserving fertility, has advanced through minimally invasive surgical techniques. This study evaluates the learning curves and surgical outcomes of three such approaches: DaVinci Robotic Single-Site (RSS), DaVinci Robotic Single-Port (RSP), and laparo-endoscopic single-site surgery (LESS). To analyze the learning curves and surgical outcomes for these techniques, providing insights into their effectiveness and proficiency development. Retrospective analysis of 104 patients with ovarian tumors, divided into RSS (n = 52), RSP (n = 22), and LESS (n = 30) groups. Metrics analyzed included age, BMI, tumor size, hemoglobin drop, operative time, docking time, console time, and tumor location. No significant differences in age, BMI, transfusion rate, hemoglobin drop, or length of stay were found among the groups. RSS had larger tumors on average, and LESS had a higher occurrence rate on the right side. LESS demonstrated the shortest operative time, while RSS and RSP had comparable times. Docking and console times did not differ significantly between RSS and RSP. RSP reached proficiency faster than RSS in docking and console times, while LESS exhibited the greatest variability in operative time. RSP offers a faster and more consistent learning curve, making it advantageous for complex procedures, whereas LESS provides shorter operative times but with higher variability. These findings are crucial for surgical training and resource allocation in medical institutions.

P-738 Reproductive surgery for fertility preservation: Robotic single-port myomectomy (da Vinci® SP) versus robotic single-site myomectomy (da Vinci® Xi or Si)

Abstract Study question To compare clinical and surgical outcomes of robotic single-port myomectomy using da Vinci® SP and robotic single-site myomectomy with Xi or Si for fertility preservation. Summary answer The robotic single-port myomectomy (da Vinci® SP) might be feasible, even if the myoma is deep-seated, compared to robotic single-site myomectomy (Xi or Si system). What is known already Myomas are clinically apparent in about 25% of women and become symptomatic in their reproductive age. Myomectomy is the choice of treatment for women desiring uterine preservation, especially in deep-seated fibroid that can affect pregnancy. Although young women prefer minimal invasive surgical technique with less scar, single-port laparoscopic myomectomy has some limitations. Adoption of the da Vinci® system made it possible to overcome the weaknesses of laparoscopy. Owing to the ability of single-port laparoscopy to reduce pain and improve patient satisfaction, robotic single-site surgery was developed in order of the da Vinci® Si, Xi and the latest new SP system. Study design, size, duration We retrospectively reviewed medical records of 214 patients who underwent robotic single-port myomectomy (RSPM, n = 111) using the da Vinci® SP surgical system or robotic single-site myomectomy (RSSM, n = 103) with the da Vinci® Xi or Si system between October 2015 and September 2023 at Ewha Womans University Mokdong Hospital. Baseline characteristics and operative outcomes were compared and analyzed between the RSPM and RSSM groups. Participants/materials, setting, methods We assessed FIGO classification and maximum diameter of fibroid. The incision time, docking time, console time, wound closure time, total operation time, estimated blood loss (EBL), chopping time for specimen removal, the number and weight of removed myoma were measured. Main results and the role of chance Mean age (38.5±6.6 vs 37.3±6.6 years) and anthropometric index were not significantly different between RSPM and RSSM groups. Although the diameter (7.1±1.4 vs 7.2±2.0 cm), number (3.1±2.7 vs 2.5±2.2), and weight (149.1±107.1 vs 146.4±130.6 g) of myoma were not significantly different between the two groups, the more deep-seated myoma diagnosed by FIGO classification (2.9±1.5 vs 4.6±2.0, p<0.0001) could be resected in RSPM group. The incision (3.6±1.9 vs 7.3±4.4 min, p <0.0001) and docking time (2.7±1.4 vs 4.6±1.6 min. p<0.0001) were less in the group of RSPM compared to RSSM that was earlier implementation. Depending on the differences in da Vinci® SP and Xi or Si systems, the wound was slightly larger, requiring shorter chopping time (6.4±5.0 vs 8.4±7.2 min, p=0.022) and longer closure time (12.8±4.4 vs 10.9±3.6 min, p=0.001) in the RSPM group. Additionally, more complex surgeries with larger blood loss (264.1±140.2 vs 176.8±132.0 ml, p<0.0001), longer console time (60.5±33.2 vs 49.7±22.6 min, p=0.016) and hospitalization (4.6±0.9 vs 4.3±0.6 days, p=0.005) were performed in the RSPM group, but the difference in hemoglobin (2.5±1.0 vs 2.6±0.9 g/dL) before and after surgery was not significant. Limitations, reasons for caution All surgeries underwent using the da Vinci systems by one gynecologic surgeon who had experience performing almost 2,000 gynecologic robotic surgeries and the follow-up period was not enough to conclude the reproductive outcome. Wider implications of the findings The RSPM using the da Vinci® SP surgical system could be recommended for patient who planned future pregnancy. However, the optimal surgical technique should be selected for successful fertility preservation of reproductive surgery. Trial registration number 2023-03-038

(016) SALVAGE VAGINOPLASTY WITH SINGLE-PORT ROBOT ASSISTED TUBULARIZED URACHUS PERITONEAL HINGE FLAP: TECHNIQUE HIGHLIGHTS, OUTCOMES, AND AN EVIDENCE-BASED PROPOSAL FOR HOW AND WHEN TO USE (AND NOT USE!) PERITONEUM WITH VAGINOPLASTY

Abstract Introduction Vaginoplasty is a commonly performed genital gender affirming surgery. Currently there are two published techniques that describe using peritoneal tissue to contribute to the necessary tissue to line the neovaginal canal: The modified Davydov technique, first described in 2019 by Zhao et al, and the Tubularized Urachus-Peritoneal Hinge Flap, described by Garcia et al in 2022. Today many providers use the Davydov technique at time of primary vaginoplasty, while other providers argue that use of peritoneum is not necessary at the time of primary vaginoplasty. We use the urachus flap only for salvage surgery. Objective Herein, we report our technical innovations related to the urachus hinge flap, and our clinical outcomes at 1.5 years post-op. We also review the literature to determine whether there is evidence to support using peritoneum at time of primary vaginoplasty. Methods We review our single-port robot assisted urachus hinge flap technique to augment neovaginal depth after primary vaginoplasty complicated by loss of vaginal depth. We also review technical innovations to maximize neovaginal depth with primary vaginoplasty using only penile and scrotal skin. We present our literature review, and posit a theory that explains why, regardless of PV technique, mean neovaginal depth is 11-13 cm in all series. Results Our mean neovaginal depth after our salvage urachus hinge flap technique is 12.5 cm (range 11-14.2) at 409 days post-op. This is comparable to the Davydov PV technique. With primary vaginoplasty using only penile and scrotal skin, our mean depth is 12.5 cm, which is > other series using only penile/scrotal skn, and comparable to series that also use peritoneum. We use video to show how, with the Davydov technique, rectum and bowel are pulled deep into the pelvis post-op, which increases risk of bowel injury at time of salvage surgery with intestine. Conclusions By the techniques described herein, in our hands, with primary vaginoplasty using only penile and scrotal skin we achieve vaginal depth comparable to techniques that augment with peritoneum. We suggest that peritoneum is rarely to never necessary at primary vaginoplasty, and should be reserved for use as a salvage surgery if and when it is needed. We also suggest that the urachus flap is a safer alternative to the Davydov technique if and when PV fails and salvage intestinal vaginoplasty must be undertaken. Disclosure No.

Comparing advanced platforms for local excision of rectal lesions.

Transanal surgery facilitates organ preservation in select patients with benign and early malignant rectal lesions to avoid the functional consequences of radical surgery. The transanal endoscopic microsurgery (TEM) platform created a standard for local excision with lower margin positivity and recurrence rates than traditional transanal excision. The single-port robot (SP r) presents a promising alternative transanal platform. The goal of this study was to compare perioperative and pathologic outcomes of TEM and SP r for excision of rectal lesions. A review of consecutive patients who underwent local excision of rectal lesions at a tertiary referral center from 1/2001 to 5/2022 was performed. Cases were stratified into TEM or SP rTAMIS in a 1:1 propensity score-matched cohort, adjusting for all baseline characteristics. Clinical, tumor-specific, and perioperative outcomes were compared using χ2, and Mann-Whitney U-tests. The main outcomes were oncologic quality measures, complications, and operative time. Matching resulted 50 patients in each cohort. Groups had similar age, gender, body mass index, comorbidity, diagnosis, lesion characteristics, and neoadjuvant chemoradiation rates. There were no intraoperative complications in either cohort. Three SP rTAMIS cases were converted intraoperatively; there were no conversions in TEM. SP rTAMIS had significantly shorter operative times than TEM (mean 104 vs. 245, p = 0.027). The rates of positive distal margins (2% TEM, 0% SP rTAMIS) and piecemeal resection (4% TEM, 0% SP rTAMIS) were similar. SP rTAMIS had significantly lower postoperative morbidity rates than TEM (9% vs. 20%, p = 0.031). There was no mortality in either cohort. SP robotics provided high-quality outcomes similar to TEM for local excision of rectal lesions. SP robotics had faster operative time with comparable clinical and oncologic outcomes to TEM. These early data are promising for expanding use of SP robotic platforms.

Single-port robotic-assisted laparoscopic synchronous surgery in pediatric patent processus vaginalis

PurposePatent processus vaginalis (PPV) is usually observed in pediatric abdominal surgery; however, robotic single-port surgery in repairing processus vaginalis has not been reported in children. Herein, we present our clinical experiences in single-port robotic surgeries for PPV repair to evaluate both efficacy and safety.MethodsRetrospective analysis of patients underwent single-port robotic-assisted laparoscopic surgery for genitourinary diseases from May 2020 and May 2023 in our center. Among these patients, 21 children had PPV repaired at the same time. The case characteristics and follow-up data were recorded.ResultsTwenty-one of the 53 children were found to have PPV during genitourinary surgery. The simultaneous treatment of the primary disease and PPV with a single-port robotic-assisted platform was both convenient and safe. There was no significant increase in total operation time, and no excessive intraoperative hemorrhage was observed in any of the operations. There were no complications observed on follow-up.ConclusionWith a high incidence of PPV in children, a single-port robotic-assisted procedure is feasible and effective if simultaneously performed when addressing a primary abdominal disease.

Postoperative Outcomes and Analgesic Requirements of Single-Port vs Multiport Robotic-Assisted Radical Cystectomy.

Objective: To compare outcomes in patients undergoing robotic-assisted radical cystectomy (RARC) with urinary diversion for bladder cancer with either the single-port (SP) or multiport (MP) robotic platform. Methods: All patients who underwent SP and MP RARC at our institution between January 2018 and January 2023 were retrospectively reviewed. Postoperative analgesia was administered by a departmentwide narcotic stewardship protocol, and inpatient and outpatient narcotic use was tracked. The available preoperative clinical, operative, and postoperative outcomes were analyzed using t-test, chi-square, and Fischer exact statistical measures. Kaplan-Meier analysis with log-rank testing was used to determine the freedom from high-grade (Clavien-Dindo grade ≥3) postoperative complications stratified by SP or MP robotic use. Results: Overall, 96 patients underwent RARC with urinary diversion at our institution, with 49 MP and 47 SP procedures performed. Preoperative clinical parameters including age, body mass index, prior abdominal surgery, and use of neoadjuvant chemotherapy were similar between the two groups. Patients undergoing SP RARC had a shorter operative time (386.0 ± 90.9 minutes vs 453.6 ± 94.8 minutes, p < 0.01) and faster return of bowel function (3.4 ± 1.4 days vs 4.5 ± 2.2 days, p < 0.01). However, both cohorts had similar length of hospitalization, postoperative narcotic use, pathologic staging, and rate of positive surgical margin. Within 3 months postoperatively, both cohorts had a similar high-grade complication, hospital readmission, and cancer recurrence rate. Conclusions: The SP robot allows a safe alternative surgical approach for RARC and offers similar postoperative outcomes compared to the MP robot.

Single incision robotic cystectomy and urinary diversion.

In this review, we aim to provide readers with a balanced understanding of all aspects of single incision robotic cystectomy (SIRC) and urinary diversion using the single-port (SP) robot. The review will trace the historical progression from open surgery to the introduction of minimally invasive approaches and present an in-depth description of the SIRC technique, offering a step-by-step guide for reference. Emphasis will be placed on indications and patient selection criteria to equip surgeons with well-rounded insights for decision-making. The review analyzes preliminary surgical outcomes by drawing from existing literature and clinical experiences, endeavoring to present a balanced view of the potential benefits and limitations. Addressing the learning curve and training prerequisites is paramount, and this review explores strategies and challenges in preparing surgeons for proficiency. Finally, the focus shifts to current challenges and future directions, identifying key issues and potential advancements in the field. By presenting historical context, technical insights, clinical evidence, and strategic foresight, the review aims to provide a comprehensive resource that engages surgeons, researchers, and trainees from diverse perspectives.

Safety and Feasibility of Single-Port Robotic-Assisted Nipple-Sparing Mastectomy

Robotic-assisted nipple-sparing mastectomies with multiport robots have been described in the US since 2015; however, significant hurdles to multiport robotic surgery exist in breast surgery. To demonstrate that the single-port da Vinci SP (Intuitive Surgical) robotic system is feasible in patients undergoing robotic nipple-sparing mastectomy (rNSM). An initial case series of 20 patients at a large university hospital underwent bilateral single-port robotic nipple-sparing mastectomies (SPrNSM) with tissue expander reconstruction from February 1, 2020, through January 4, 2023. Participants included women who met surgical criteria for nipple-sparing mastectomies, per standard of care. Surgery using a single-port robot and the surgical technique of the authors. Age, indication, body mass index, breast size, operative time, conversion to open surgery, systemic complications, postoperative skin necrosis, and reported skin and nipple areolar complex (NAC) sensation. Twenty women aged 29 to 63 years (median, 40 years) underwent bilateral SPrNSM. Eleven patients completed prophylactic surgery due to a high risk for breast cancer (more than 20% lifetime risk) and 9 patients had breast cancer. Breast size ranged from A through D cup with median B cup and a body mass index range of 19.7 through 27.8 (median 24.4). The total duration of the procedure from incision to skin closure for both sides ranged from 205 minutes to 351 minutes (median, 277). The median robotic time for bilateral SPrNSM was 116 minutes and varied by cup size (A cup, 95 minutes; B cup, 140 minutes; C cup, 118 minutes; D cup, 114 minutes) with no inflection point in learning curve. No cases were converted to open and no immediate complications, such as hematoma, positive margins, or recurrence, were seen. In the first 10 patients prior to routine sensation testing, 20 resected breasts had measurable NAC sensation at a range from 4 to 36 months post-index resection (65%). In the second 10 patients of the cohort, measurable NAC was preserved in 13 of 20 resected breasts 2 weeks following the index operation (65%). In this case series, SPrNSM with immediate reconstruction was feasible and performed safely by an experienced breast surgeon with limited previous robotic training. Further studies confirming the preliminary data demonstrating improved NAC and skin sensation following SPrNSM are warranted. ClinicalTrials.gov Identifier: NCT05245812.

Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis.

Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries. A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis. There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = - 0.63, 95% Cl [- 1.06, - 0.21], P < 0.05), less estimated blood loss (WMD = - 19.56, 95% Cl [- 32.21, - 6.91], P < 0.05), less lymph node yields (WMD = - 3.35, 95% Cl [- 5.16, - 1.55], P < 0.05), less postoperative opioid use (WMD = - 5.86, 95% Cl [- 8.83, - 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate. Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.

Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: a comparative analysis in colorectal cancer surgery.

Single-incision laparoscopic surgery (SILS) may offer improved cosmesis, reduced postoperative pain and faster recovery than conventional platforms, but widespread implementation was limited by technical demands. A single-port robotic platform was recently introduced, with components that further enhance SILS benefits without the technical challenges. No study to date has compared the two platforms to validate benefits. Our goal was to compare outcomes of SP robotics and SILS in colorectal cancer (CRC). A prospective cancer registry was reviewed for CRC patients undergoing curative resection through a SILS or SP robotic approach from 2010 to 2022. Patient and cancer demographics, intraoperative, and postoperative outcomes were compared in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. The main outcome measures were complications, operative time, and oncologic quality measures. Matching resulted 50 SP robotic and 50 SILS patients. Cohorts were well matched in all demographics, but SP robotic rectal cancer cases were significantly closer to the anorectal ring than SILS (1.8cm vs. 3.4cm, p = 0.018). SP robotic and SILS platforms had similar operative times. Intraoperative conversions was comparable, but more SILS cases required additional ports to be placed (p = 0.040). The intraoperative complications rate, complete total mesorectal excision rates, and lymph node yield were not statistically significantly different. There were no positive margins in either group. Postoperatively, groups had analogous day of return of bowel function, comparable morbidity, and discharge destination. There was no mortality in either group. The length of stay was significantly shorter with SP robotics than SILS (mean 4.135 vs. 5.282days, median 4 (2-8) vs. 5 (2-14) days; p = 0.045). Single-port robotics provided high quality oncologic surgery, adding the technical benefits of robotics to clinical and cosmetic benefits of single-port surgery. There were comparable operative time, complication rates, and oncologic outcomes in CRC cases, with shorter hospital stays with SP robotics. This early data is encouraging for expansion SP robotic technology.

Single-port Transvesical Robot-Assisted Simple Prostatectomy: Surgical Technique and Clinical Outcomes

BackgroundSurgical management of large prostatic adenomas can be performed via open, endoscopic, or robotic approaches. A low-profile single-port (SP) robot was built to work in confined areas (ie, the bladder) and regionalize surgery. ObjectiveTo describe the novel SP transvesical (TV) robot-assisted simple prostatectomy (RASP) and report clinical outcomes. Design, setting, and participantsSP TV RASP cases were performed in an academic hospital by two surgeons from 2019 to 2023. A total of 117 cases were performed, and data from patients with at least 12 mo of follow-up were analyzed. The inclusion criterion was severe obstructive urinary symptoms or catheter-dependent urinary retention due to large prostates with volume >80 ml. Surgical procedureThe procedure consisted of two main steps through a single 3-cm suprapubic incision: first, enucleation of the adenoma, and second, a 360° bladder mucosal flap reconstruction. No drains or continuous bladder irrigation was used routinely. MeasurementsIntraoperative parameters, pre- and postoperative uroflowmetry, and 1-yr clinical outcomes were assessed. We used descriptive statistics to analyze the data. Results and limitationsAll procedures were completed successfully without additional ports or conversions. The median console time and estimated blood loss were 107 min and 100 ml, respectively. Transfusion rate was 0%. Intraoperative complications included two suspected air emboli attributed to high insufflation pressures. There were no major postoperative complications. In total, 95.8% were discharged within the first 24 h, with a median length of stay and pain score of 5 h and 3/10, respectively. There was persistent improvement in the median International Prostate Symptom Score and flow rate after 1 yr. The median Sexual Score Inventory for Men score was 20 at 12 mo. Our study is limited by its retrospective nature and cohort size. ConclusionsSP TV RASP is a feasible alternative for the management of severe benign prostatic hyperplasia that promotes fast recovery and demonstrates 1-yr improvement in urinary function. Patient summarySingle-port transvesical robot-assisted simple prostatectomy is a minimally invasive alternative for the treatment of large benign prostatic growth. A single robotic arm goes through a small incision in the skin and bladder to extract the obstructive prostatic tissue. Afterward, reconstruction of the area is done to decrease bleeding and improve postoperative symptoms. We found that patients recover quickly and have excellent clinical results with a low risk of complications.

Single port (SP) robotic pyeloplasty in a pediatric patient

We began using the da Vinci single port (SP) robot for pediatric urologic surgeries at our institution due to limited access to the multiport robot. Availability of this technology has allowed us to schedule cases in a timelier fashion and increase access to minimally invasive urologic surgery for children in our area. Here, we report our technique for transperitoneal SP robotic pyeloplasty in the case of a 7 year-old boy with left ureteropelvic junction obstruction. Our technique was refined over a series of 10 patients under the age of 18. Highlights of the SP RALP technique include one 3cm, concealed incision over the pubic tubercle, gentle frog leg positioning and burping of the boom to create optimal angle for robotic docking, and use of a "floating dock" to obtain 10cm distance from target anatomy which is essential in smaller pediatric patients. SP pyeloplasty is safe and feasible in children and offers a concealed single incision alternative to the multiport approach.

단일공 다빈치로봇을 이용하여 헤어라인 절개를 통한 일차성 부갑상선 증대증 수술 1예

The da Vinci single port(SP) robotic system features a single arm design that may be particularly suitable for procedures requiring long and narrow working spaces, such as thyroidectomy. Recent advances in preoperative localization studies and the increasing demand for scarless surgery have spurred research into remote surgical techniques for parathyroid surgery. The hairline approach appears to offer the most convenient and safest access to the neck. In this paper, we share our preliminary experience with SP robotic parathyroidectomy, employing only a hairline incision, in one patient with primary hyperparathyroidism. The operation lasted 35 minutes and the console time was 15 minutes. There were no postoperative complications. The SP robot parathyroidectomy using a hairline incision is a viable and safe, providing improved surgical exposure and instrument manipulation.

Comparison of the efficacy and safety of single-port versus multi-port robotic total mesorectal excision for rectal cancer: A propensity score-matched analysis

BackgroundIt is unknown whether the da Vinci single-port system performs similarly to the previous multi-port system during complicated procedures, such as rectal cancer surgery. Therefore, we compared the short-term clinical outcomes of single-port and multi-port robotic total mesorectal excision for the treatment of rectal cancer. MethodsThis retrospective study reviewed 128 patients who underwent robotic total mesorectal excision between July 2020 and June 2022, of whom 84 (42 each: single-port versus multi-port) were included in the propensity score-matched cohort. Perioperative and pathologic outcomes were compared between groups. ResultsMedian tumor height was similar between groups (single-port versus multi-port, 5.9 ± 2.1 vs 5.6 ± 1.8 cm, P = .719). Preoperative chemoradiotherapy was performed equally. The total operative time was less (160.0 ± 42.2 minutes vs 199.6 ± 78.6 minutes, P = .005), the total length of incision was shorter (4.0 ±0.3 vs 5.4 ± 0.7 cm, P = .003), postoperative hospital stay was shorter (6.2 ±1.7 vs 7.2 ±2.8 days, P = .050), and C-reactive protein levels on postoperative day 3 trended to be lower (7.3 ± 4.7 vs 8.9 ± 5.6 mg/L, P = .096) in the single-port group, compared with the multi-port group. Postoperative complications did not differ between groups (single-port versus multi-port, 11.9% vs 16.6%, P = .864). Anastomotic leakage occurred in 1 and 2 patients in the single-port and multi-port groups, respectively. The circumferential resection margins were positive in 1 patient in the multi-port group. ConclusionThe perioperative outcomes of single-port robotic total mesorectal excision were comparable to those of multi-port robotic TME. The single-port robot can be considered a surgical option for treating rectal cancer.