da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access
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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.
KeywordsRobotic-assisted surgery Single-incision laparoscopic surgery (SILS) Laparoscopic cholecystectomy Laparoscopic hepatectomy Reduced port laparoscopic surgery (RPLS)
- 2.Jayaraman S, Davies W, Schlachta CM. Robot-assisted minimally invasive common bile duct exploration: a Canadian first. Can J Surg. 2008;51:93–4.Google Scholar
- 4.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).Google Scholar
- 14.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).Google Scholar
- 23.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).Google Scholar
- 26.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).Google Scholar
- 32.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.PubMedCrossRefGoogle Scholar