Journal of Gastrointestinal Surgery

, Volume 15, Issue 12, pp 2182–2186 | Cite as

Robotic Single-Port Cholecystectomy Using a New Platform: Initial Clinical Experience

  • Philippe Morel
  • Monika E. Hagen
  • Pascal Bucher
  • Nicolas C. Buchs
  • Francois Pugin
Original Article



The technique of single-port laparoscopy was developed over the past years in an attempt to reduce the invasiveness of surgery. A reduction of incisions and their overall size might result in enhanced postoperative cosmesis and potentially reduce pain when compared to conventional techniques. While manual single-port laparoscopy is technically challenging, a newly approved robotic platform used with the da Vinci Si System (Intuitive Surgical, Sunnyvale, CA, USA) might overcome some of the difficulties of this technique.


Patients with cholelithiasis were scheduled for robotic single-port cholecystectomy in an initial clinical trial. Demographic data, intra- and short-term postoperative results were assessed prospectively.


Twenty-eight patients (22 females/6 males; median age, 48 years) underwent robotic single-port cholecystectomy in our first week of clinical cases. Median OR time was 80 min with a median docking time of 8 min and median robotic console time of 53 min. Two patients underwent intraoperative cholangiography. Eight cases presented with adhesions, tissue alterations, or anatomical abnormalities. No conversions, intra- or postoperative complications occurred.


Robotic single-port cholecystectomy appears feasible and safe in our early experience. The robotic approach to single-port surgery seems to overcome some of the technical difficulties of manual single-port surgery. This robotic platform may facilitate completion of more complex cases.


Robotic surgery Single incision Laparoendoscopic single site SILS Laparoscopy 



Dr. Monika Hagen has a financial relationship with Intuitive Surgical. All other authors have nothing to disclose.


  1. 1.
    Swain P, Bagga HS, Su LM. Status of endoscopes and instruments used during NOTES. J Endourol 2009;23:773–780.PubMedCrossRefGoogle Scholar
  2. 2.
    Swanström LL. Natural orifice transluminal endoscopic surgery. Endoscopy 2009;41:82–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Bucher P, Pugin F, Morel P, Hagen M. Scarless surgery: Myth or reality through NOTES? Chirurgie sans cicatrice: Mythe ou réalité grâce à la chirurgie par les orifices naturels? Rev Med Suisse 2008;4:1550–1552.PubMedGoogle Scholar
  4. 4.
    Besarani D, Umranikar S, Patil K. Single-port ‘scarless’ laparoscopic nephrectomies: The United Kingdom experience. BJU Int 2009;104:1795–1796.PubMedCrossRefGoogle Scholar
  5. 5.
    Allemann P, Schafer M, Demartines N. Critical appraisal of single port access cholecystectomy. Br J Surg 2010;97:1476–1480.PubMedCrossRefGoogle Scholar
  6. 6.
    Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS. Laparoendoscopic single site cholecystectomy: The first 100 patients. Am Surg 2009;75:681–685.PubMedGoogle Scholar
  7. 7.
    Rivas H, Varela E, Scott D. Single-incision laparoscopic cholecystectomy: Initial evaluation of a large series of patients. Surg Endosc 2010;24:1403–1412.PubMedCrossRefGoogle Scholar
  8. 8.
    Curcillo Ii PG, 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 (2010) Poor A. Single-port-access (SPA™) cholecystectomy: A multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860.CrossRefGoogle Scholar
  9. 9.
    Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 2009;23:1660–1666.PubMedCrossRefGoogle Scholar
  10. 10.
    Kirschniak A, Bollmann S, Pointner R, Granderath FA. Transumbilical single-incision laparoscopic cholecystectomy: Preliminary experiences. Surg Laparosc Endosc Percutan Techn 2009;19:436–438.CrossRefGoogle Scholar
  11. 11.
    Hagen ME, Wagner OJ, Christen D, Morel P. Cosmetic issues of abdominal surgery: Results of an enquiry into possible grounds for a natural orifice transluminal endoscopic surgery (NOTES) approach. Endoscopy 2008;40:581–583.PubMedCrossRefGoogle Scholar
  12. 12.
    Peterson CY, Ramamoorthy S, Andrews B, Horgan S, Talamini M, Chock A. Women’s positive perception of transvaginal NOTES surgery. Surg Endosc 2009;23:1770–1774.PubMedCrossRefGoogle Scholar
  13. 13.
    Swanstrom LL, Volckmann E, Hungness E, Soper NJ. Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery. Surg Endosc 2009;23:1519–1525.PubMedCrossRefGoogle Scholar
  14. 14.
    Chouillard E, Dache A, Torcivia A, Helmy N, Ruseykin I, Gumbs A. Single-incision laparoscopic appendectomy for acute appendicitis: A preliminary experience. Surg Endosc 2010;24:1861–1865.PubMedCrossRefGoogle Scholar
  15. 15.
    Takemasa I, Sekimoto M, Ikeda M, Mizushima T, Yamamoto H, Doki Y, Mori M. Transumbilical single-incision laparoscopic surgery for sigmoid colon cancer. Surg Endosc 2010;24:2321.PubMedCrossRefGoogle Scholar
  16. 16.
    Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD. Single port access adrenalectomy. J Endourol 2008;22:1573–1576.PubMedCrossRefGoogle Scholar
  17. 17.
    Targarona EM, Pallares JL, Balague C, Luppi CR, Marinello F, Hernández P, Martínez C, Trias M. Single incision approach for splenic diseases: A preliminary report on a series of 8 cases. Surg Endosc 2010;24:2236–2240.PubMedCrossRefGoogle Scholar
  18. 18.
    Saber AA, El-Ghazaly TH, Minnick DB. Single port access transumbilical laparoscopic roux-en-y gastric bypass using the SILS port: First reported case. Surg Innov 2009;16:343–347.PubMedCrossRefGoogle Scholar
  19. 19.
    Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, Kaouk JH, Gill IS. Transumbilical Single-Port Surgery: Evolution and Current Status. Eur Urol 2008;54:1020–1030.PubMedCrossRefGoogle Scholar
  20. 20.
    Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 2011;25:367–377.PubMedCrossRefGoogle Scholar
  21. 21.
    Escobar PF, Fader AN, Paraiso MF, Kaouk JH, Falcone T. Robotic-Assisted Laparoendoscopic Single-Site Surgery in Gynecology: Initial Report and Technique. J Minim Invasive Gynecol 2009;16:589–591.PubMedCrossRefGoogle Scholar
  22. 22.
    Kaouk. Robotic single-port transumbilical surgery in humans: Initial report. BJU Int 2009;103:366–369.PubMedCrossRefGoogle Scholar
  23. 23.
    Hagen ME, Wagner OJ, Inan I, Morel P, Fasel J, Jacobsen G, Spivack A, Thompson K, Wong B, Fischer L, Talamini M, Horgan S. Robotic single-incision transabdominal and transvaginal surgery: Initial experience with intersecting robotic arms. Int J Med Robot 2010;6:251–255.PubMedCrossRefGoogle Scholar
  24. 24.
    Joseph RA, Goh AC, Cuevas SP, Donovan MA, Kauffman MG, Salas NA, Miles B, Bass BL, Dunkin BJ. “Chopstick” surgery: A novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc 2010;24:1331–1335.PubMedCrossRefGoogle Scholar
  25. 25.
    Bucher P, Pugin F, Buchs N, Ostermann S, Charara F, Morel P. Single port access laparoscopic cholecystectomy (with video). World J Surg 2009;33:1015–1019.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Philippe Morel
    • 1
  • Monika E. Hagen
    • 1
  • Pascal Bucher
    • 1
  • Nicolas C. Buchs
    • 1
  • Francois Pugin
    • 1
  1. 1.Division of Digestive Surgery, Department of SurgeryUniversity Hospital GenevaGenevaSwitzerland

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