da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Minimally invasive surgery including laparoscopic and robotic surgery was recently approved for clinical use in hepatobiliary surgery. The purpose of this article is to evaluate the feasibility and technical aspects of robotic single incision for hepatobiliary surgery using the GelPort laparoscopic system in a preliminary animal study.
We performed eight robotic single-incision laparoscopic surgery (SILS) procedures, including four cholecystectomies and four lateral segmentectomy of the liver, in a porcine study using the da Vinci S-HD Surgical System. A single-channel GelPort access was placed through a 2.5-cm single incision for robotic access. A 12-mm camera port, two 8-mm ports for the robotic arms and one 5-mm port for the patient-side assistant were inserted. A Mini Loop Retractor was applied to retract the fundus of the gallbladder. The EndoWrist dissector and grasping forceps was introduced to fine-dissect Calot’s triangle. The instruments were crossed to avoid “sword fighting” and clashing of instruments in the abdomen. The cystic duct was divided after double ligation and the gallbladder was removed. Hepatic transection was performed with bipolar Harmonic shears and LigaSure for vascular pedicles.
All robotic SILS procedures were completed (8/8, 100%). The cholecystectomies and hepatectomies were safely performed in average operating times of 70 min (±15) and 60 min (±20), respectively, with minimal blood loss. There were no conversions, re-interventions or extension of the skin incision.
Robotic hepatobiliary SILS is technically feasible and safe using GelPort as a single-incision access platform. Robotic SILS is becoming established and is enormously advantageous to the patient.
- Roeyen G, Chapelle T, Ysebaert D. Robot-assisted choledochotomy. Surg Endosc. 2004;18:165–6. CrossRef
- Jayaraman S, Davies W, Schlachta CM. Robot-assisted minimally invasive common bile duct exploration: a Canadian first. Can J Surg. 2008;51:93–4.
- Ruurda JP, van Dongen KW, Dries J, Borel Rinkes IH, Broeders IA. Robot-assisted laparoscopic choledochojejunostomy, comparison to the open approach in an experimental study. Surg Endosc. 2003;17:1937–42. CrossRef
- Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH. Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg. 2010 (Epub ahead of print).
- Idrees K, Bartlett DL. Robotic liver surgery. Surg Clin North Am. 2010;90:761–74. CrossRef
- Giulianotti PC, Giacomoni A, Coratti A, Addeo P, Bianco FM. Minimally invasive sequential treatment of synchronous colorectal liver metastases by laparoscopic colectomy and robotic right hepatectomy. Int J Colorectal Dis. 2010;25:1507–11. CrossRef
- Giulianotti PC, Addeo P, Bianco FM. Robotic right hepatectomy for giant hemangioma in a Jehovah’s Witness. J Hepatobiliary Pancreat Sci. 2011;18(1):112–8. CrossRef
- Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC, et al. Robotic liver surgery: results for 70 resections. Surgery. 2011;149:29–39. CrossRef
- Giulianotti PC, Sbrana F, Bianco FM, Addeo P. Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A. 2010;20:159–63. CrossRef
- Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L. Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg. 2009;16:450–7. CrossRef
- Choi SB, Park JS, Kim JK, Hyung WJ, Kim KS, Yoon DS, et al. Early experiences of robotic-assisted laparoscopic liver resection. Yonsei Med J. 2008;49:632–8. CrossRef
- Giulianotti PC, Addeo P, Buchs NC, Bianco FM, Ayloo SM. Early experience with robotic total pancreatectomy. Pancreas. 2011;40:311–3. CrossRef
- Ntourakis D, Marzano E, De Blasi V, Oussoultzoglou E, Jaeck D, Pessaux P. Robotic left pancreatectomy for pancreatic solid pseudopapillary tumor. Ann Surg Oncol. 2011;18:642–3. CrossRef
- Kang CM, Kim DH, Lee WJ, Chi HS. Initial experiences using robot-assisted central pancreatectomy with pancreaticogastrostomy: a potential way to advanced laparoscopic pancreatectomy. Surg Endosc. 2010 (Epub ahead of print).
- Giulianotti PC, Sbrana F, Bianco FM, Addeo P, Caravaglios G. Robot-assisted laparoscopic middle pancreatectomy. J Laparoendosc Adv Surg Tech A. 2010;20:135–9. CrossRef
- Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010;24(7):1646–57. CrossRef
- Vasilescu C, Sgarbura O, Tudor S, Herlea V, Popescu I. Robotic spleen-preserving distal pancreatectomy. A case report. Acta Chir Belg. 2009;109:396–9.
- Narula VK, Mikami DJ, Melvin WS. Robotic and laparoscopic pancreaticoduodenectomy: a hybrid approach. Pancreas. 2010;39:160–4. CrossRef
- Oberholzer J, Tzvetanov I, Mele A, Benedetti E. Laparoscopic and robotic donor pancreatectomy for living donor pancreas and pancreas–kidney transplantation. J Hepatobiliary Pancreat Sci. 2010;17:97–100. CrossRef
- Machado MA, Makdissi FF, Surjan RC, Abdalla RZ. Robotic resection of intraductal neoplasm of the pancreas. J Laparoendosc Adv Surg Tech A. 2009;19:771–5. CrossRef
- Giulianotti PC, Kuechle J, Salehi P, Gorodner V, Galvani C, Benedetti E, et al. Robotic-assisted laparoscopic distal pancreatectomy of a redo case combined with autologous islet transplantation for chronic pancreatitis. Pancreas. 2009;38:105–7. CrossRef
- Horgan S, Galvani C, Gorodner V, Bareato U, Panaro F, Oberholzer J, et al. Robotic distal pancreatectomy and nephrectomy for living donor pancreas–kidney transplantation. Transplantation. 2007;84:934–6. CrossRef
- Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res. 2010 (Epub ahead of print).
- Chow A, Purkayastha S, Aziz O, Pefanis D, Paraskeva P. Single-incision laparoscopic surgery for cholecystectomy: a retrospective comparison with 4-port laparoscopic cholecystectomy. Arch Surg. 2010;145:1187–91. CrossRef
- Barbaros U, Sümer A, Tunca F, Gözkün O, Demirel T, Bilge O, et al. Our early experiences with single-incision laparoscopic surgery: the first 32 patients. Surg Laparosc Endosc Percutan Tech. 2010;20:306–11. CrossRef
- McGregor CG, Sodergren MH, Aslanyan A, Wright VJ, Purkayastha S, Darzi A, et al. Evaluating systemic stress response in single port vs. multi-port laparoscopic cholecystectomy. J Gastrointest Surg. 2011 (Epub ahead of print).
- Kobayashi S, Nagano H, Marubashi S, Wada H, Eguchi H, Takeda Y, et al. A single-incision laparoscopic hepatectomy for hepatocellular carcinoma: initial experience in a Japanese patient. Minim Invasive Ther Allied Technol. 2010;19:367–71. CrossRef
- Sasaki K, Watanabe G, Matsuda M, Hashimoto M, Harano T. Original method of transumbilical single-incision laparoscopic deroofing for liver cyst. J Hepatobiliary Pancreat Sci. 2010;17:733–4. CrossRef
- Mori T, Kimura T, Kitajima M. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol. 2010;19:18–23. CrossRef
- Sugimoto M, Yasuda H, Koda K, Suzuki M, Yamazaki M, Tezuka T, et al. Evaluation for transvaginal and transgastric NOTES cholecystectomy in human and animal natural orifice translumenal endoscopic surgery. J Hepatobiliary Pancreat Surg. 2009;16:255–60. CrossRef
- Sugimoto M. Natural orifice translumenal endoscopic surgery (NOTES) for innovation in hepatobiliary and pancreatic surgery: preface. J Hepatobiliary Pancreat Surg. 2009;16:247–8. CrossRef
- Sugimoto M, Yasuda H, Koda K, Suzuki M, Yamazaki M, Tezuka T, et al. Rendezvous gastrotomy technique using direct percutaneous endoscopic gastrostomy for transgastric cholecystectomy in hybrid natural orifice translumenal endoscopic surgery. J Hepatobiliary Pancreat Surg. 2009;16:758–62. CrossRef
- Friedland S, Kaltenbach T, Sugimoto M, Soetikno R. Endoscopic necrosectomy of organized pancreatic necrosis: a currently practiced NOTES procedure. J Hepatobiliary Pancreat Surg. 2009;16:266–9. CrossRef
- Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg. 2007;142:823–6. CrossRef
- Bresadola F, Pasqualucci A, Donini A, Chiarandini P, Anania G, Terrosu G, et al. Elective transumbilical compared with standard laparoscopic cholecystectomy. Eur J Surg. 1999;165:29–34. CrossRef
- Hirano Y, Watanabe T, Uchida T, Yoshida Y, Tawaraya K, Kato H, et al. Single-incision laparoscopic cholecystectomy: single institution experience and literature review. World J Gastroenterol. 2010;16:270–4. CrossRef
- da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access
Journal of Hepato-Biliary-Pancreatic Sciences
Volume 18, Issue 4 , pp 493-498
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Robotic-assisted surgery
- Single-incision laparoscopic surgery (SILS)
- Laparoscopic cholecystectomy
- Laparoscopic hepatectomy
- Reduced port laparoscopic surgery (RPLS)
- Industry Sectors
- Author Affiliations
- 1. Department of Gastroenterology, Kobe University Graduate School of Medicine, National University Corporation, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
- 2. Foundation for Kobe International Medical Alliance, Kobe, Japan