SP Surgical System Research Articles

Transcervical minimally invasive esophagectomy using da Vinci® SP™ Surgical System: a feasibility study in cadaveric model.

This is a preclinical cadaveric study to investigate the feasibility of transcervical esophagectomy using a novel single-port robotic surgical system. A 40-mm cervical incision was created over left supraclavicular fossa. The novel da Vinci® SP™ Surgical System was introduced through a wound retraction port. The mobilization of esophagus was performed using da Vinci SP from cervical, thoracic to abdominal segments. Lymph nodes were dissected en bloc with esophagus. The transcervical esophagectomy with complete mobilization of the cervical, thoracic, and abdominal esophagus was completed in 60min. The procedure was completed using the novel da Vinci SP Surgical System, which was introduced via the cranial side over the left cervical incision. No additional port was used for retraction and dissection, and the esophageal hiatus could be reached after complete transcervical dissection. This preclinical study demonstrated that transcervical esophagectomy is technically feasible and can be completed with the novel da Vinci SP Surgical System without additional ports or assistance. This will serve as an important step to the performance of robotic transcervical esophagectomy without the necessity of one-lung ventilation.

Pure single-site robot-assisted pyeloplasty with the da Vinci SP surgical system: Initial experience.

PurposeLaparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy while providing superior cosmetic results. However, LESS remains a challenging surgical technique, even in robotic surgery, primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP surgical system (Intuitive Surgical) was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the da Vinci SP surgical system.Materials and MethodsThree consecutive patients who were diagnosed with UPJO underwent RAP with the da Vinci SP surgical system from December 2018 to February 2019 at our institution. The surgical technique involved reproducing the steps of multi-port RAP. A 30-mm umbilical incision was made and the GelPOINT was inserted. The multichannel robotic port and the assistant's port were placed through the GelSeal cap. In all patients, Anderson–Hynes dismembered pyeloplasty was performed. The ureteral double J stent was inserted antegrade, and the drain was not placed.ResultsThe procedures were successfully completed using a pure single-site approach. There was no need for additional port placement or conversion to laparoscopic or open surgery. Total operative time in the three patients was 139, 180, and 213 minutes, respectively. No intraoperative complications occurred, and blood loss was minimal. The postoperative course of all patients was uneventful with no complications greater than Clavien–Dindo grade I surgical complications.ConclusionsPure single-site RAP using the da Vinci SP surgical system is feasible and safe.

Pure Single-Site Robot-Assisted Partial Nephrectomy Using the SP Surgical System: Initial Clinical Experience

ObjectivesTo describe the technique of pure single-site trans-peritoneal robotic partial nephrectomy using the da Vinci SP surgical system. MethodsThree consecutive patients who were diagnosed with contrast-enhanced renal masses amenable of partial nephrectomy were scheduled for robot-assisted partial nephrectomy to be performed using the SP Surgical System.Data collection received Institutional Review Board Approval (IRB 13-780). Subjects were provided with informed consent explaining the adoption of the novel surgical platform.The procedures were performed by reproducing the steps of the standard institutional multiarms robotic approach to partial nephrectomy. ResultsThe surgeries were successfully performed. There was no need for conversion to standard multiports robotic approach nor need for additional ports placement. All the procedures were completed according to a pure single-site approach. No intraoperative complications occurred. The total robotic operative time averaged 180 minutes. The warm ischemia time averaged 25 minutes. Blood loss averaged 180 mL. One patient had postoperative acute bleeding and underwent angioembolization. All patients had negative surgical margins. ConclusionThe feasibility of pure single-site transperitoneal robot-assisted partial nephrectomy using the novel SP surgical system is demonstrated. Further studies are needed to confirm the results reported herein.

Abstract 23: A flexible next-generation robotic system for transoral robotic nasopharyngectomy: A comparative preclinical study

Abstract Objective: To compare the technical efficacy and extent of instrument reach in performing transoral robotic nasopharyngectomy with the current da Vinci Si surgical robot system (Intuitive Surgical Inc., Sunnyvale CA) and the flexible next-generation robotic system (Da Vinci SP Surgical System, Model SP999, Endo Wrist SP, Intuitive Surgical, Inc.). Study Design: Preclinical study using human cadaver. Materials and Method: Transoral resection of the nasopharyngeal wall and dissection of the parapharyngeal fat space from midline was performed on one side with the da Vinci Si robotic system and the da Vinci SP robotic system on the contra-lateral side in a fresh cadaver. The soft palate was elevated with sutures. For the da Vinci Si system, a 12-mm 30o telescope facing superiorly with 5-mm Maryland forceps and 5-mm monopolar cautery was used to perform the dissection. For the da Vinci SP system, the flexible camera system with 6-mm monopolar cautery spatula, 6-mm bipolar Maryland forceps and 6-mm prograsp forceps were employed for dissection. Results: The mouth opening was 5 cm. Comparing the surgical view, the da Vinci SP system gave a much wider view with both Eustachian tube opening visible and the whole posterior edge of the vomer in view. In the da Vinci Si system, only the Eustachian tube cushion of the side of dissection was visible and only the attachment of the vomer bone to the roof of the nasopharynx was visible. For instrument reach, the da Vinci SP system can dissect up to 2 cm lateral to the medial pterygoid plate while the da Vinci Si system can only reach 1 cm beyond the medial pterygoid plate laterally. In the da Vinci SP system, all 3 instruments arms together with the flexible camera could be deployed for dissection. Occasional collisions of the robotic arms inside the oral cavity can be resolved by the console surgeon adjusting the positions of the robotic instruments. On the da Vinci Si system, only 2 robotic arms and the camera arm can be deployed as the external part of the robotic arms are bulky and prevented deployment of all 4 arms. External collision of the robotic arms occurred frequently and in several instance required the bedside surgeon to reposition the robotic arms. Conclusion: The flexible next-generation surgical robotic system provided superior visualization of the nasopharynx and allowed dissection with 3 robotic instruments. Compared with a standard robotic system, the flexible next-generation surgical robotic system can reach more laterally into the parapharyngeal space to perform dissection. Citation Format: Raymond King-Yin Tsang, Chris Holsinger. A flexible next-generation robotic system for transoral robotic nasopharyngectomy: A comparative preclinical study [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 23.

A Novel Robotic System for Single-port Urologic Surgery: First Clinical Investigation

BackgroundThe idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. ObjectiveTo determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. Design, setting, and participantsThis was a prospective institutional review board–approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. InterventionDifferent types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. Outcome measurements and statistical analysisThe main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. Results and limitationsA total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. ConclusionsWe describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. Patient summaryA novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. Trial registrationThe study was registered on www.ClinicalTrials.gov (NCT02136121).