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Surgical Endoscopy

, Volume 24, Issue 12, pp 3224–3224 | Cite as

Chopstick surgery: a novel technique enables use of the Da Vinci Robot to perform single-incision laparoscopic surgery

  • R. A. JosephEmail author
  • N. A. Salas
  • C. Johnson
  • A. Goh
  • S. P. Cuevas
  • M. A. Donovan
  • M. G. Kaufman
  • B. Miles
  • P. R. Reardon
  • B. L. Bass
  • B. J. Dunkin
Video

Introduction

Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with “wristed” instruments could overcome this limitation but the “arms” collide when working coaxially. This video demonstrates a new technique of “chopstick surgery,” which enables use of the robotic arms through a single incision without collision.

Methods

Experiments were conducted utilizing the da Vinci S® robot (Sunnyvale, CA) in a porcine model with three laparoscopic ports (12 mm, 2–5 mm) introduced through a single “incision.” Pilot work conducted while performing Fundamentals of Laparoscopic Surgery (FLS) tasks determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, an experienced robotic surgeon performed a cholecystectomy and nephrectomy in a porcine model utilizing the “chopstick” technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This arrangement prevents collision of the external robotic arms. To correct for the change in handedness, the robotic console is instructed to drive the “left” instrument with the right hand effector and the “right” instrument with the left.

Results

Both procedures were satisfactorily completed with no external collision of the robotic arms, in acceptable times and with no technical complications. This is consistent with results obtained in the box trainer where the chopstick configuration enabled significantly improved times in all tasks and decreased number of errors and eliminated instrument collisions.

Conclusion

Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.

Keywords

Porcine Model Port Arrangement Surgical Robot Laparoscopic Port Optimal Setup 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosures

Drs. Rohan A. Joseph, Nilson A. Salas, Alvin Goh, Patrick R. Reardon, Barbara L. Bass, and Brian J. Dunkin, and Mr. Matthew Kauffman, Mike Donovan, and Chris Johnson have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 56874 kb)

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • R. A. Joseph
    • 1
    Email author
  • N. A. Salas
    • 1
  • C. Johnson
    • 1
  • A. Goh
    • 2
  • S. P. Cuevas
    • 1
  • M. A. Donovan
    • 1
  • M. G. Kaufman
    • 1
  • B. Miles
    • 1
  • P. R. Reardon
    • 1
  • B. L. Bass
    • 1
  • B. J. Dunkin
    • 1
  1. 1.Department of Surgery, Methodist Institute for Technology Innovation and Education (MITIE™)The Methodist HospitalHoustonUSA
  2. 2.Department of UrologyBaylor College of MedicineHoustonUSA

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