V2158: ROBOTIC SINGLE SITE KIDNEY SURGERY: EARLY EXPERIENCE IN A CADAVER MODEL WITH NOVEL PURPOSE-BUILT INSTRUMENTS
VideoIntroduction 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.
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
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.
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
Funding: Intuitive Surg.