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Standard and Robot-Assisted Laparoendoscopic Single-Site Urologic Surgery

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Minimally Invasive Urology

Abstract

Laparoendoscopic single-site surgery (LESS) is appropriate for patients interested in better cosmesis. The approach is challenging for the surgeon and requires consistent experience. Nevertheless, the threshold for conversion to standard laparoscopy should be low. Better instrumentation, especially dedicated robotic platforms, may enable the wider use of LESS.

It has been established that robotic-assisted laparoscopic surgery has several advantages when compared to standard laparoscopic surgery. Optics, ergonomics, dexterity, and precision are all enhanced with the use of the robotic platform for a number of urologic procedures. For these reasons, it was postulated that the application of robotics to LESS could overcome some of the constraints seen with the conventional laparoscopic approach. Issues such as instrument clashing, inability to achieve effective triangulation for dissection, and difficulties with intracorporeal suturing have limited the widespread adoption of conventional LESS in urology. No particular advantages have been observed when performing robotic-LESS by using conventional robotic platforms. The advent to the market of a new surgical system specifically designed for single-site surgery could be an option to fill the gap presented with the older generations and robotics systems. Recent publications have shown the feasibility of different conventional and unconventional approaches for almost all the major urological procedures.

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References

  1. Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology. 2007;70(6):1039–42.

    Article  PubMed  Google Scholar 

  2. Desai MM, Rao PP, Aron M, Pascal-Haber G, Desai MR, Mishra S, et al. Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int. 2008;101(1):83–8.

    Article  PubMed  Google Scholar 

  3. Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG 2nd, et al. Consensus statement of the consortium for laparoendoscopic single site surgery. Surg Endosc. 2010;24(4):762–8.

    Article  PubMed  Google Scholar 

  4. Guillotreau J, Crouzet S, Haber GP. Access techniques, platforms and instruments for LESS. Arch Esp Urol. 2012;65(3):285–93.

    PubMed  Google Scholar 

  5. Cadeddu J, Fernandez R, Desai M, Bergs R, Tracy C, Tang SJ, et al. Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc. 2009;23(8):1894–9.

    Article  PubMed  Google Scholar 

  6. Raman JD, Scott DJ, Cadeddu JA. Role of magnetic anchors during laparoendoscopic single site surgery and NOTES. J Endourol. 2009;23(5):781–6.

    Article  PubMed  Google Scholar 

  7. Canes D, Lehman AC, Farritor SM, et al. The future of NOTES instrumentation: flexible robotics and in vivo minirobots. J Endourol. 2009;23(5):787–92.

    Article  PubMed  Google Scholar 

  8. Kaouk JH, Goel RK, Haber GP, Crouzet S, Stein RJ. Robotic single-port transumbilical surgery in humans: initial report. BJU Int. 2008;103(3):366–9.

    Article  PubMed  Google Scholar 

  9. Stein RJ, White WM, Goel RK, Irwin BH, Haber GP, Kaouk JH. Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol. 2010;57(1):132–6.

    Article  PubMed  Google Scholar 

  10. White MA, Autorino R, Spana G, Laydner H, Hillyer SP, Khanna R, et al. Robotic laparoendoscopic single-site radical nephrectomy: surgical technique and comparative outcomes. Eur Urol. 2011;59(5):815–22.

    Article  PubMed  Google Scholar 

  11. White MA, Haber GP, Autorino R, Khanna R, Forest S, Yang B, et al. Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol. 2010;58(4):544–50.

    Article  PubMed  Google Scholar 

  12. Arkoncel FR, Lee JW, Rha KH, Han WK, Jeoung HB, Oh CK. Two-port robot-assisted vs standard robot assisted laparoscopic partial nephrectomy: a matched pair comparison. Urology. 2011;78(3):581–5.

    Article  PubMed  Google Scholar 

  13. Olweny EO, Park SK, Tan YK, Gurbuz C, Cadeddu JA, Best SL. Perioperative comparison of robotic assisted laparoendoscopic single-site (LESS) pyeloplasty versus conventional LESS pyeloplasty. Eur Urol. 2012;61(2):410–4.

    Article  PubMed  Google Scholar 

  14. Joseph RA, Goh AC, Cuevas SP, Donovan MA, Kauffman MG, Salas NA, et al. Chopstick surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc. 2010;24(6):1331–5.

    Article  PubMed  Google Scholar 

  15. Haber GP, White MA, Autorino R, Escobar PF, Kroh MD, Chalikonda S, et al. Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology. 2010;76(6):1279–82.

    Article  PubMed  Google Scholar 

  16. Kaouk JH, Autorino R, Kim FJ, Han DH, Lee SW, Yinghao S, et al. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol. 2011;60(5):998–1005.

    Article  PubMed  Google Scholar 

  17. Fareed K, Zaytoun OM, Autorino R, White WM, Crouzet S, Yakoubi R, et al. Robotic single port suprapubic transvesical enucleation of the prostate (R-STEP): initial experience. BJU Int. 2012;110(5):732–7.

    Article  PubMed  Google Scholar 

  18. Won Lee J, Arkoncel FR, Rha KH, Choi KH, Yu HS, Chae Y, Han WK. Urologic robot-assisted laparoendoscopic single-site surgery using a homemade single-port device: a single-center experience of 68 cases. J Endourol. 2011;25(9):1481–5.

    Article  PubMed  Google Scholar 

  19. Autorino R, Kaouk JH, Stolzenburg JU, Gill IS, Mottrie A, Tewari A, Cadeddu JA. Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol. 2013;63(2):266–80.

    Article  PubMed  Google Scholar 

  20. White MA, Autorino R, Spana G, Hillyer S, Stein RJ, Kaouk JH. Robotic laparoendoscopic single site urological surgery: analysis of 50 consecutive cases. J Urol. 2012;187(5):1696–701.

    Article  PubMed  Google Scholar 

  21. Seideman CA, Tan YK, Faddegon S, Park SK, Best SL, Cadeddu JA, Olweny EO. Robot assisted laparoendoscopic single-site pyeloplasty: technique using the da Vinci Si robotic platform. J Endourol. 2012;26(8):971–4.

    Article  PubMed  Google Scholar 

  22. Joseph RA, Salas NA, Johnson C, Goh A, Cuevas SP, Donovan MA, et al. Video. Chopstick surgery: a novel technique enables use of the da Vinci robot to perform single-incision laparoscopic surgery. Surg Endosc. 2010;24(12):3224.

    Article  CAS  PubMed  Google Scholar 

  23. Kaouk JH, Autorino R, Laydner H, Hillyer S, Yakoubi R, Isac W, et al. Robotic single-site kidney surgery: evaluation of second-generation instruments in a cadaver model. Urology. 2012;79(5):975–9.

    Article  PubMed  Google Scholar 

  24. Morel P, Hagen ME, Bucher P, Buchs NC, Pugin F. Robotic single port cholecystectomy using a new platform: initial clinical experience. J Gastrointest Surg. 2011;15(12):2182–6.

    Article  PubMed  Google Scholar 

  25. Konstantinidis KM, Hirides P, Hirides S, Chrysocheris P, Georgiou M. Cholecystectomy using a novel Single-Site® robotic platform: early experience from 45 consecutive cases. Surg Endosc. 2012;26(9):2687–94.

    Article  PubMed  Google Scholar 

  26. Cestari A, Buffi NM, Lista G, Lughezzani G, Larcher A, Lazzeri M, et al. Feasibility and preliminary clinical outcomes of robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-port platform. Eur Urol. 2012;62(1):175–9.

    Article  PubMed  Google Scholar 

  27. Khanna R, Stein RJ, White MA, Isac W, Laydner H, Autorino R, et al. Single institution experience with robot-assisted laparoendoscopic single-site renal procedures. J Endourol. 2012;26(3):230–4.

    Article  PubMed  Google Scholar 

  28. Tobis S, Houman J, Thomer M, Rashid H, Wu G. Robot-assisted transumbilical laparoendoscopic single-site pyeloplasty: technique and perioperative outcomes from a single institution. J Laparoendosc Adv Surg TechA. 2013;23(8):702–6.

    Article  Google Scholar 

  29. Park JH, Kim SY, Lee CR, Park S, Jeong JS, Kang SW, et al. Robot-assisted posterior retroperitoneoscopic adrenalectomy using single-port access: technical feasibility and preliminary results. Ann Surg Oncol. 2013;20(8):2741–5.

    Article  PubMed  Google Scholar 

  30. Kaouk JH, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A. A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol. 2014;66(6):1033–43.

    Article  PubMed  Google Scholar 

  31. Kaouk JH, Akca O, Zargar H, Caputo P, Ramirez D, Andrade H. Descriptive technique and initial results for robotic radical perineal prostatectomy. Urology. 2016;94:129–38.

    Article  PubMed  Google Scholar 

  32. Maurice M, Ramirez D, Kaouk J. Robotic laparoendoscopic single-site retroperitioneal renal surgery: initial investigation of a purpose-built single-port surgical system. Eur Urol. 2017;71(4):643–7.

    Article  PubMed  Google Scholar 

  33. Garisto J, Bertolo R, Kaouk J. Technique for docking and port placement using a purpose-built robotic system (SP1098) in human cadaver. Urology. 2018;119:91–6.

    Article  PubMed  Google Scholar 

  34. Kaouk J, Bertolo R, Eltemamy M, Garisto J. Single-port robot-assisted radical prostatectomy: first clinical experience using the SP surgical system. Urology. 2019;124:309.

    Article  PubMed  Google Scholar 

  35. Kaouk J, Garisto J, Eltemamy M, Bertolo R. Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP® surgical system. BJU Int. 2019;123(4):733–9.

    Article  CAS  PubMed  Google Scholar 

  36. Kaouk J, Garisto J, Eltemamy M, Bertolo R. Pure single-site robot- assisted partial nephrectomy using the SP surgical system: initial clinical experience. Urology. 2019;124:282–5.

    Article  PubMed  Google Scholar 

  37. Kaouk J, Garisto J, Bertolo R. Robotic urologic surgical interventions performed with the single port dedicated platform: first clinical investigation. Eur Urol. 2019;75(4):684–91.

    Article  PubMed  Google Scholar 

  38. Kaouk J, Bertolo R. Single-site robotic platform in clinical practice: first cases in the USA. Minerva Urol Nefrol. 2019;71:294–8. https://doi.org/10.23736/S0393-2249.19.03384-8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Robotic and Image Guided Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Riccardo Bertolo, Rair José Valero Carrion & Jihad H. Kaouk

Authors
  1. Riccardo Bertolo
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  2. Rair José Valero Carrion
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  3. Jihad H. Kaouk
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Corresponding author

Correspondence to Jihad H. Kaouk .

Editor information

Editors and Affiliations

  1. Department of Urology, University of Wisconsin–Madison, Madison, WI, USA

    Sara L. Best

  2. Department of Urology, University of Wisconsin–Madison, Madison, WI, USA

    Stephen Y. Nakada

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Bertolo, R., Valero Carrion, R.J., Kaouk, J.H. (2020). Standard and Robot-Assisted Laparoendoscopic Single-Site Urologic Surgery. In: Best, S., Nakada, S. (eds) Minimally Invasive Urology. Springer, Cham. https://doi.org/10.1007/978-3-030-23993-0_10

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  • DOI: https://doi.org/10.1007/978-3-030-23993-0_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23992-3

  • Online ISBN: 978-3-030-23993-0

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