Surgical Endoscopy

, Volume 27, Issue 9, pp 3182–3186 | Cite as

Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task

  • Dan Eisenberg
  • Tamas J. Vidovszky
  • James Lau
  • Bernadette Guiroy
  • Homero Rivas



Laparoendoscopic single-site (LESS) surgery has been established for various procedures. Shortcomings of LESS surgery include loss of triangulation, instrument collisions, and poor ergonomics, making advanced laparoscopic tasks especially challenging. We compared a LESS system with a robotic single-site surgery platform in performance of a suturing and knot-tying task under clinically simulated conditions.


Each of five volunteer minimally invasive surgeons was tasked with suturing a 5 cm longitudinal enterotomy in porcine small intestine with square knots at either end, using a laparoendoscopic or da Vinci robotic single-site surgery platform, within a 20 min time limit. A saline leak test was then performed. Each surgeon performed the task twice using each system. The time to completion of the task and presence of a leak were noted. Fisher’s exact test was used to compare the overall completion rate within the defined time limit, and a Wilcoxon rank test was used to compare the specific times to complete the task. A p value of <0.05 was considered significant.


All surgeons were able to complete the task on the first try within 20 min using the robot system; 60 % of surgeons were able to complete it after two attempts using the LESS surgery system. Time to completion using the robot system was significantly shorter than the time using the standard LESS system (p < 0.0001). There were no leaks after closure with the robot system; the leak rate following the standard LESS system was 90 %.


Surgeons demonstrated significantly better suturing and knot-tying capabilities using the robot single-site system compared to a standard LESS system. The robotic system has the potential to expand single-site surgery to more complex tasks.


da Vinci Laparoscopy LESS Robot Single-site surgery Suturing 


  1. 1.
    NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269:1018–1024CrossRefGoogle Scholar
  2. 2.
    Allen JW, Rivas H, Cocchione RN, Ferzli GS (2003) Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy. JSLS 7:137–140PubMedGoogle Scholar
  3. 3.
    Stefanidis D, Hope WW, Korndorffer JR Jr, Markley S, Scott DJ (2010) Initial laparoscopic basic skills training shortens the learning curve of laparoscopic suturing and is cost-effective. J Am Coll Surg 210:436–440PubMedCrossRefGoogle Scholar
  4. 4.
    Ross S, Rosemurgy A, Albrink M, Choung E, Dapri G, Gallagher S, Hernandez J, Horgan S, Kelley W, Kia M, Marks J, Martinez J, Mintz Y, Oleynikov D, Pryor A, Rattner D, Rivas H, Roberts K, Rubach E, Schwaitzberg S, Swanstrom L, Sweeney J, Wilson E, Zemon H, Zundel N (2012) Consensus statement of the consortium for LESS cholecystectomy. Surg Endosc 26:2711–2716PubMedCrossRefGoogle Scholar
  5. 5.
    Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery—current status and controversies. J Minim Access Surg 7:6–16PubMedGoogle Scholar
  6. 6.
    Schill MR, Varela JE, Frisella MM, Brunt LM (2012) Comparison of laparoscopic skills performance between single-site access (SSA) devices and an independent-port SSA approach. Surg Endosc 26:714–721PubMedCrossRefGoogle Scholar
  7. 7.
    Endo T, Nagasawa K, Umemura K, Baba T, Henmi H, Saito T (2011) A remarkably easy knot-tying technique for single-incision laparoscopic surgery with the SILS port for gynecologic diseases. J Minim Invasive Gynecol 18:500–502PubMedCrossRefGoogle Scholar
  8. 8.
    Wren SM, Curet MJ (2011) Single-port robotic cholecystectomy; results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg 146:1122–1127PubMedCrossRefGoogle Scholar
  9. 9.
    Escobar PF, Knight J, Rao S, Weinberg L (2012) da Vinci single-site platform: anthropometrical, docking and suturing considerations for hysterectomy in the cadaver model. Int J Med Robot 8:191–195PubMedCrossRefGoogle Scholar
  10. 10.
    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695PubMedCrossRefGoogle Scholar
  11. 11.
    Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG 2nd, Desai MM, Evanko JC, Falcone T, Fazio V, Gettman M, Gumbs AA, Haber GP, Kaouk JH, Kim F, King SA, Ponsky J, Remzi F, Rivas H, Rosemurgy A, Ross S, Schauer P, Sotelo R, Speranza J, Sweeney J, Teixeira J (2010) Consensus statement of the consortium for laparoscopic single-site surgery. Surg Endosc 24:762–768PubMedCrossRefGoogle Scholar
  12. 12.
    Curcillo PG 2nd, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, Dunham R, Fendley S, Neff M, Copper C, Bessler M, Gumbs AA, Norton M, Iannelli A, Mason R, Moazzez A, Cohen L, Mouhlas A, Poor A (2010) Single-port access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860PubMedCrossRefGoogle Scholar
  13. 13.
    Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, Lai PB, Ng EK (2012) A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg 256:909–914PubMedCrossRefGoogle Scholar
  14. 14.
    Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto G, Rivas H, Islam A, Soper N, Gecelter G, Rubach E, Paraskeva P, Shah S (2012) Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 26:1296–1303PubMedCrossRefGoogle Scholar
  15. 15.
    Pfluke JM, Parker M, Stauffer JA, Paetau AA, Bowers SP, Asbun HJ, Smith CD (2011) Laparoscopic surgery performed through a single incision: systematic review of current literature. J Am Coll Surg 212:113–118PubMedCrossRefGoogle Scholar
  16. 16.
    Song T, Kim TJ, Lee YY, Choi CH, Lee JW, Kim BG, Bae DS (2012) Learning curves for single-site laparoscopic ovarian surgery. J Minim Invasive Gynecol 19:344–349PubMedCrossRefGoogle Scholar
  17. 17.
    Park YH, Balk KD, Lee YJ, Kim KT, Kim HH (2012) Learning curve analysis for laparoendoscopic single-site radical nephrectomy. J Endourol 26:494–498PubMedCrossRefGoogle Scholar
  18. 18.
    Gawart M, Dupitron S, Lutfi R (2012) Laparoendoscopic single-site gastric bands versus standard multiport gastric bands: a comparison of technical learning curve measured by surgical time. Am J Surg 203:327–329PubMedCrossRefGoogle Scholar
  19. 19.
    Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E (2009) Trans-umbilical gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 13:159–162PubMedCrossRefGoogle Scholar
  20. 20.
    Pietrabissa A, Sbrana F, Morelli L, Badessi F, Pugliese L, Vinci A, Klersy C, Spinoglio G (2012) Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology. Arch Surg 147:709–714PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Dan Eisenberg
    • 1
    • 2
  • Tamas J. Vidovszky
    • 3
  • James Lau
    • 1
  • Bernadette Guiroy
    • 4
  • Homero Rivas
    • 1
  1. 1.Department of SurgeryStanford School of MedicineStanfordUSA
  2. 2.Department of SurgeryPalo Alto Veterans Affairs Health Care SystemPalo AltoUSA
  3. 3.Department of SurgeryUniversity of California, Davis Medical CenterSacramentoUSA
  4. 4.Department of SurgerySalinas Memorial HospitalSalinasUSA

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