Surgical Endoscopy

, 25:3566 | Cite as

First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform

  • Matthew Kroh
  • Kevin El-Hayek
  • Steven Rosenblatt
  • Bipan Chand
  • Pedro Escobar
  • Jihad Kaouk
  • Sricharan Chalikonda



Interest in single-incision laparoscopic techniques continues to grow. A learning curve certainly exists, and although the techniques have improved, technical considerations including external clashes, poor visualization of critical structures, and surgeon fatigue remain. Applications of robotics to these newer techniques are evolving. The da Vinci Single-Site robotic surgery platform is a new semi-rigid robotic operative system designed to work with the Intuitive Surgical da Vinci Si operative system. The authors present the first human experience with this new device used to perform single-incision laparoscopic cholecystectomy. This study aimed to present the first human experience performing cholecystectomy with a novel robotic single-port platform.


After Cleveland Clinic Institutional Review Board approval, patients with symptomatic biliary disease fitting standard criteria for cholecystectomy were enrolled in the study. A total of 13 consecutive single-port, robotic cholecystectomy operations were performed. Patient demographics and operative results were evaluated.


All 13 operations were completed successfully with the Single-Site platform. A critical view of safety as determined by the operative surgeon was obtained in all cases. One patient required placement of an additional extra-umbilical trocar for appropriate visualization secondary to gallbladder necrosis, and this incision also was used for eventual drain placement. For two patients, an intraoperative choloangiogram was performed. The mean operative time was 107 ± 54 min, and the mean docking time was 15 ± 9 min. Discharge for 11 patients was within 24 h. No significant complications occurred.


Cholecystectomy using the da Vinci Single-Site system is feasible. Availability of this new semi-rigid, robotic surgery platform may increase access to the potential advantages of single-site surgery. Additional advantages of single-site surgery may be elucidated with further studies.


Da Vinci Single-Site system Single-incision laparoscopic cholecystectomy Single-incision laparoscopy Single-site robotic surgery 



Matthew Kroh, Pedro Escobar, Jihad Kaouk, and Sricharan Chalikonda serve as consultants for Intuitive Surgical, Sunnyvale, CA, USA. Kevin El-Hayek, Steven Rosenblatt, and Bipan Chand have no conflicts of interest or financial ties to disclose.


  1. 1.
    Rivas H, Varela E, Scott D (2010) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24:1403–1412PubMedCrossRefGoogle Scholar
  2. 2.
    Curcillo PG II et al (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860PubMedCrossRefGoogle Scholar
  3. 3.
    Raman SR et al (2011) Does transumbilical single incision laparoscopic adjustable gastric banding result in decreased pain medicine use? A case-matched study. Surg Obes Relat Dis 7(2):129–133PubMedCrossRefGoogle Scholar
  4. 4.
    Chow A et al (2010) Single-incision laparoscopic surgery for cholecystectomy: a retrospective comparison with 4-port laparoscopic cholecystectomy. Arch Surg 145:1187–1191PubMedCrossRefGoogle Scholar
  5. 5.
    Chamberlain RS, Sakpal SV (2009) A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg 13:1733–1740PubMedCrossRefGoogle Scholar
  6. 6.
    Joseph RA et al (2009) “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc 24:1331–1335PubMedCrossRefGoogle Scholar
  7. 7.
    Kaouk JH et al (2009) Robotic single-port transumbilical surgery in humans: initial report. BJU Int 103:366–369PubMedCrossRefGoogle Scholar
  8. 8.
    Haber GP et al (2010) Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology 76:1279–1282PubMedCrossRefGoogle Scholar
  9. 9.
    Escobar PF et al (2009) Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. J Minim Invasive Gynecol 16:589–591PubMedCrossRefGoogle Scholar
  10. 10.
    Navarra G et al (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695PubMedCrossRefGoogle Scholar
  11. 11.
    Elsey JK, Feliciano DV (2010) Initial experience with single-incision laparoscopic cholecystectomy. J Am Coll Surg 210:624–626CrossRefGoogle Scholar
  12. 12.
    Philipp SR, Miedema BW, Thaler K (2009) Single-incision laparoscopic cholecystectomy using conventional instruments: early experience in comparison with the gold standard. J Am Coll Surg 209:632–637PubMedCrossRefGoogle Scholar
  13. 13.
    Hodgett SE et al (2009) Laparoendoscopic single-site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192PubMedCrossRefGoogle Scholar
  14. 14.
    Nguyen NT et al (2009) A single-port technique for laparoscopic extended stapled appendectomy. Surg Innov 16:78–81PubMedCrossRefGoogle Scholar
  15. 15.
    Nguyen NT et al (2008) Single laparoscopic incision transabdominal (SLIT) surgery—adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631PubMedCrossRefGoogle Scholar
  16. 16.
    Reavis KM et al (2008) Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg 18:1492–1494PubMedCrossRefGoogle Scholar
  17. 17.
    Geisler DP, Condon ET, Remzi FH (2010) Single-incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12:941–943PubMedCrossRefGoogle Scholar
  18. 18.
    Stein RJ et al (2010) Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol 57:132–136PubMedCrossRefGoogle Scholar
  19. 19.
    Kroh M, Rosenblatt S (2009) Single-port, laparoscopic cholecystectomy and inguinal hernia repair: first clinical report of a new device. J Laparoendosc Adv Surg Tech A 19:215–217PubMedCrossRefGoogle Scholar
  20. 20.
    Jacob BP et al (2009) Single-incision total extraperitoneal (one SITE) laparoscopic inguinal hernia repair using a single-access port device. Hernia 13:571–572PubMedCrossRefGoogle Scholar
  21. 21.
    Filipovic-Cugura J et al (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23:920–921PubMedCrossRefGoogle Scholar
  22. 22.
    Vidal O et al (2009) Laparoendoscopic single-site cholecystectomy: a safe and reproducible alternative. J Laparoendosc Adv Surg Tech A 19:599–602PubMedCrossRefGoogle Scholar
  23. 23.
    Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168PubMedCrossRefGoogle Scholar
  24. 24.
    Tantia O et al (2008) Iatrogenic biliary injury: 13, 305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg Endosc 22:1077–1086PubMedCrossRefGoogle Scholar
  25. 25.
    Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125PubMedGoogle Scholar
  26. 26.
    Kravetz AJ et al (2009) The learning curve with single-port cholecystectomy. JSLS 13:332–336PubMedGoogle Scholar
  27. 27.
    Chiruvella A et al (2010) Iatrogenic combined bile duct and right hepatic artery injury during single-incision laparoscopic cholecystectomy. JSLS 14:268–271PubMedCrossRefGoogle Scholar
  28. 28.
    Walsh M. Personal communicationGoogle Scholar
  29. 29.
    Rawlings A et al (2010) Single-incision laparoscopic cholecystectomy: initial experience with critical view of safety dissection and routine intraoperative cholangiography. J Am Coll Surg 211:1–7PubMedCrossRefGoogle Scholar
  30. 30.
    White MA et al (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58:544–550PubMedCrossRefGoogle Scholar
  31. 31.
    Ciulla A et al (2006) Gallbladder carcinoma late metastases and incisional hernia at umbilical port site after laparoscopic cholecystectomy. G Chir 27:214–216PubMedGoogle Scholar
  32. 32.
    Rice DC et al (1997) Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J Gastrointest Surg 1:85–90 discussion 90–91PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Matthew Kroh
    • 1
  • Kevin El-Hayek
    • 1
  • Steven Rosenblatt
    • 1
  • Bipan Chand
    • 1
  • Pedro Escobar
    • 2
  • Jihad Kaouk
    • 3
  • Sricharan Chalikonda
    • 1
  1. 1.Cleveland ClinicDigestive Disease InstituteClevelandUSA
  2. 2.Cleveland ClinicWomen’s Health InstituteClevelandUSA
  3. 3.Cleveland ClinicGlickman Urologic InstituteClevelandUSA

Personalised recommendations