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da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access

  • Topics
  • Robotic surgery and emerging endoscopic surgery for hepatobiliary pancreatic sciences
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

This study was partially supported by a Grant-in-Aid for Scientific Research funded by the Japan Society for the Promotion of Science (JSPS), the project “Computational Anatomy for Computer-aided Diagnosis and Therapy: Frontiers of Medical Image Sciences” funded by Grant-in-Aid for Scientific Research on Innovative Areas, The Ministry of Education, Culture, Sports, Science and Technology (MEXT) Japan, Japan NOTES Research Grant, Hyogo Science and Technology Association, and JFE Grant from the Japanese Foundation for Research and Promotion of Endoscopy.

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Authors and Affiliations

  1. Department of Gastroenterology, Kobe University Graduate School of Medicine, National University Corporation, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Maki Sugimoto, Mari Man-i, Yoshinori Morita, Shinwa Tanaka, Shoko Fujiwara & Takeshi Azuma

  2. Foundation for Kobe International Medical Alliance, Kobe, Japan

    Koichi Tanaka & Yuichiro Matsuoka

Authors
  1. Maki Sugimoto
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  2. Koichi Tanaka
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  3. Yuichiro Matsuoka
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  4. Mari Man-i
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  5. Yoshinori Morita
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  6. Shinwa Tanaka
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  7. Shoko Fujiwara
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  8. Takeshi Azuma
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Corresponding author

Correspondence to Maki Sugimoto.

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Cite this article

Sugimoto, M., Tanaka, K., Matsuoka, Y. et al. da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access. J Hepatobiliary Pancreat Sci 18, 493–498 (2011). https://doi.org/10.1007/s00534-011-0387-4

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  • DOI: https://doi.org/10.1007/s00534-011-0387-4

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