Single-Access Robotic Surgery

  • A. PeriEmail author
  • A. Vinci
  • L. Pugliese
  • S. Bogliolo
  • A. Spinillo
  • A. Pietrabissa


The volume of available clinical outcomes of robotic laparoendoscopic single-site surgery (R-LESS) has considerably grown since the pioneering description of the first successful clinical series of single-port robotic procedures. The feasibility of robot-assisted single-incision urologic and colorectal, as well as of many gynecologic, procedures has been demonstrated. A novel set of single-site instruments specifically dedicated to LESS is now commercially available for use with the da Vinci Si Surgical System, and both experimental and clinical uses have been reported. However, the current robotic systems were specifically designed for LESS. The ideal robotic platform should have a low external profile, the possibility of being deployed through a single-access site, and the possibility of restoring intra-abdominal triangulation while maintaining the maximum degree of freedom for precise maneuvers and strength for reliable traction.


Laparoscopic Cholecystectomy Robotic Surgery Partial Nephrectomy Robotic Port Multichannel Port 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Box G, Averch T, Cadeddu J et al (2008) Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology. J Endourol 22:2575–2578PubMedCrossRefGoogle Scholar
  2. 2.
    Autorino R, Cadeddu JA, Desai MM et al (2011) Laparoendoscopic single site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 59:26–45PubMedCrossRefGoogle Scholar
  3. 3.
    Gettman MT, White WM, Aron M et al (2011) Where do we really stand with LESS and NOTES? Eur Urol 59:231–234PubMedCrossRefGoogle Scholar
  4. 4.
    Raman JD, Bagrodia A, Cadeddu JA (2009) Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 55:1198–1206PubMedCrossRefGoogle Scholar
  5. 5.
    Canes D, Berger A, Aron M et al (2010) Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 57:95–101PubMedCrossRefGoogle Scholar
  6. 6.
    Kaouk JH, Autorino R, Kim FJ et al (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 60:998–1005PubMedCrossRefGoogle Scholar
  7. 7.
    Greco F, Cindolo L, Autorino R et al (2012) Laparoendoscopic single-site upper urinary tract surgery: assessment of postoperative complications and analysis of risk factors. Eur Urol 61:510–516PubMedCrossRefGoogle Scholar
  8. 8.
    Haber GP, Autorino R, Laydner H et al (2012) SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application. Eur Urol 61:415–422PubMedCrossRefGoogle Scholar
  9. 9.
    White MA, Haber GP, Autorino R et al (2010) Robotic laparoendoscopic single-site surgery. BJU Int 106:923–927PubMedCrossRefGoogle Scholar
  10. 10.
    Rane A, Autorino R (2011) Robotic natural orifice translumenal endoscopic surgery and laparoendoscopic single-site surgery: current status. Curr Opin Urol 21:71–77PubMedCrossRefGoogle Scholar
  11. 11.
    Spana G, Rane A, Kaouk JH (2011) Is robotics the future of laparoendoscopic single-site surgery (LESS)? BJU Int 108:1018–1023PubMedCrossRefGoogle Scholar
  12. 12.
    Rane’ A, Tan GY, Tewari AK (2009) Laparo-endoscopic single-site surgery in urology: is robotics the missing link? BJU Int 104:1041–1043CrossRefGoogle Scholar
  13. 13.
    Kaouk JH, Goel RK, Haber GP et al (2009) Robotic single-port transumbilical surgery in humans: initial report. BJU Int 103:366–369PubMedCrossRefGoogle Scholar
  14. 14.
    Tang B, Hou S, Cuschieri SA (2012) Ergonomics of and technologies for single-port laparoscopic surgery. Minim Invasive Ther Allied Technol 21:46–54PubMedCrossRefGoogle Scholar
  15. 15.
    Escobar PF, Starks D, Fader AN, Catenacci M, Falcone T (2010) Laparoendoscopic single-site and natural orifice surgery in gynecology. Fertil Steril 94:2497–2502 [16]PubMedCrossRefGoogle Scholar
  16. 16.
    Joseph RA, Goh AC, Cuevas SP et al (2010) “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc 24:1331–1335PubMedCrossRefGoogle Scholar
  17. 17.
    Joseph RA, Salas NA, Johnson C et al (2010) Chopstick surgery: a novel technique enables use of the da Vinci robot to perform single-incision laparoscopic surgery [video]. Surg Endosc 24:3224PubMedCrossRefGoogle Scholar
  18. 18.
    Allemann P, Leroy J, Asakuma M, Al Abeidi F, Dallemagne B, Marescaux J (2010) Robotics may overcome technical limitations of single-trocar surgery: an experimental prospective study of Nissen fundoplication. Arch Surg 145:267–271PubMedCrossRefGoogle Scholar
  19. 19.
    Sugimoto M, Tanaka K, Matsuoka Y et al (2011) da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access. J Hepatobiliary Pancreat Sci 18:493–498PubMedCrossRefGoogle Scholar
  20. 20.
    Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5(10):561–568PubMedCrossRefGoogle Scholar
  21. 21.
    Ostrowitz MB, Eschete D, Zemon H, DeNoto G (2009) Robotic-assisted single-incision right colectomy: early experience. Int J Med Robot 5(4):465–470PubMedCrossRefGoogle Scholar
  22. 22.
    Barret E, Sanchez-Salas R, Kasraeian A et al (2009) A transition to laparoendoscopic single-site surgery (LESS) radical prostatectomy: human cadaver experimental and initial clinical experience. J Endourol 23:135–140Google Scholar
  23. 23.
    Hagen ME, Wagner OJ, Inan I et al (2010) Robotic single-incision transabdominal and transvaginal surgery: initial experience with intersecting robotic arms. Int J Med Robot 6(3):251–255PubMedCrossRefGoogle Scholar
  24. 24.
    Desai MM, Aron M, Berger A et al (2008) Transvesical robotic radical prostatectomy. BJU Int 102(11):1666–1669PubMedCrossRefGoogle Scholar
  25. 25.
    Ragupathi M, Ramos-Valadez DI, Pedraza R, Haas EM (2010) Robotic-assisted single-incision laparoscopic partial cecectomy. Int J Med Robot 6(3):362–367PubMedCrossRefGoogle Scholar
  26. 26.
    Stein RJ, White WM, Goel RK et al (2010) Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol 57(1):132–136PubMedCrossRefGoogle Scholar
  27. 27.
    Arkoncel FRP, Lee JW, Rha KH et al (2011) Two-port robot-assisted vs standard robot-assisted laparoscopic partial nephrectomy: a matched-pair comparison. Urology 78(3):581–585, 44PubMedCrossRefGoogle Scholar
  28. 28.
    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(10):1122–1127PubMedCrossRefGoogle Scholar
  29. 29.
    Kaouk JH, Goel RK (2009) Single-port laparoscopic and robotic partial nephrectomy. Eur Urol 55(5):1163–1169PubMedCrossRefGoogle Scholar
  30. 30.
    Escobar PF, Fader AN, Paraiso MF et al (2009) Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. J Minim Invasive Gynecol 16(5):589–591, 25PubMedCrossRefGoogle Scholar
  31. 31.
    Fader AN, Escobar PF (2009) Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 114(2):157–161, 26PubMedCrossRefGoogle Scholar
  32. 32.
    White WM, Haber G-P, Goel RK et al (2009) Single-port urological surgery: single-center experience with the first 100 cases. Urology 74(4):801–804, 27PubMedCrossRefGoogle Scholar
  33. 33.
    Romanelli JR, Roshek TB, Lynn DC 3rd, Earle DB (2010) Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24(6):1374–1379, 28PubMedCrossRefGoogle Scholar
  34. 34.
    Haber G-P, White MA, Autorino R et al (2010) Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology 76(6):1279–1282PubMedCrossRefGoogle Scholar
  35. 35.
    Escobar PF, Kebria M, Falcone T (2011) Evaluation of a novel single- port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology. Gynecol Oncol 120(3):380–384, 31PubMedCrossRefGoogle Scholar
  36. 36.
    Kroh M, El-Hayek K, Rosenblatt S et al (2011) First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci single-site platform. Surg Endosc 25(11):3566–3573PubMedCrossRefGoogle Scholar
  37. 37.
    Morel P, Hagen ME, Bucher P et al (2011) Robotic single-port cholecystectomy using a new platform: initial clinical experience. J Gastrointest Surg 15(12):2182–2186, 34PubMedCrossRefGoogle Scholar
  38. 38.
    White MA, Autorino R, Spana G et al (2011) Robotic laparoendoscopic single-site radical nephrectomy: surgical technique and comparative outcomes. Eur Urol 59(5):815–822, 35PubMedCrossRefGoogle Scholar
  39. 39.
    Greco F, Veneziano D, Wagner S et al (2012) Laparoendoscopic single-site radical nephrectomy for renal cancer: technique and surgical outcomes. Eur Urol 62:168–174PubMedCrossRefGoogle Scholar
  40. 40.
    Wang GJ, Afaneh C, Aull M et al (2011) Laparoendoscopic single site live donor nephrectomy: single institution report of initial 100 cases. J Urol 186:2333–2337PubMedCrossRefGoogle Scholar
  41. 41.
    Stolzenburg JU, Do M, Haefner T et al (2011) Laparoendoscopic single-site surgery radical nephrectomy. J Endourol 25:159–165, 28PubMedCrossRefGoogle Scholar
  42. 42.
    Park JH, Walz MK, Kang SW et al (2011) Robot-assisted posterior retroperitoneoscopic adrenalectomy: single port access. J Korean Surg Soc 81(Suppl 1):S21–S24 [34]PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Kaouk JH, Goel RK, Haber GP, Crouzet S, Desai MM, Gill IS (2008) Single-port laparoscopic radical prostatectomy. Urology 72:1190–1193 [38]PubMedCrossRefGoogle Scholar
  44. 44.
    Barret E, Sanchez-Salas R, Kasraeian A et al (2009) A transition to laparoendoscopic single-site surgery (LESS) radical prostatectomy: human cadaver experimental and initial clinical experience. J Endourol 23:135–140PubMedCrossRefGoogle Scholar
  45. 45.
    Barret E, Sanchez-Salas R, Cathelineau X et al (2009) Re: initial complete laparoendoscopic single-site surgery robotic assisted radical prostatectomy (LESS-RARP). Int Braz J Urol 35:92–93PubMedGoogle Scholar
  46. 46.
    White MA, Haber GP, Autorino R et al (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58:544–550 [42]PubMedCrossRefGoogle Scholar
  47. 47.
    Desai MM, Fareed K, Berger AK et al (2010) Single-port transvesical enucleation of the prostate: a clinical report of 34 cases. BJU Int 105:1296–1300PubMedCrossRefGoogle Scholar
  48. 48.
    Fareed K, Zaytoun OM, Autorino R et al (2012) Robotic single port suprapubic transvesical enucleation of the prostate (R-STEP): initial experience. BJU Int 110:732–737 [44]PubMedCrossRefGoogle Scholar
  49. 49.
    Cela V, Freschi L, Simi G, Ruggiero M, Tana R, Pluchino N (2013) Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome. Surg Endosc 27:2638–2643PubMedCrossRefGoogle Scholar
  50. 50.
    Fagotti A, Corrado G, Fanfani F et al (2013) Robotic single-site hysterectomy (RSS-H) vs. laparoendoscopic single-site hysterectomy (LESS-H) in early endometrial cancer: a double-institution case-control study. Gynecol Oncol 130:219–223PubMedCrossRefGoogle Scholar
  51. 51.
    Vizza E, Corrado G, Mancini E et al (2013) Robotic single-site hysterectomy in low risk endometrial cancer: a pilot study. Ann Surg Oncol. doi: 10.1245/s10434-013-2922-9 [Online March 7, 2013]Google Scholar
  52. 52.
    Bogliolo S, Cassani C, Babilonti L, Musacchi V, Nappi RE, Spinillo A (2013) Robotic single site hysterectomy with bilateral salpingo-oophorectomy in female to male transsexualism. J Sex Med. doi: 10.1111/jsm.12356 PubMedGoogle Scholar
  53. 53.
    Bogliolo S, Cassani C, Babilonti L, Spinillo A (2013) Vaginal cuff closure during robotic single-port hysterectomy: is vaginal route always the best one? Surg Endosc. doi: 10.1007/s00464-013-3106-1 PubMedGoogle Scholar
  54. 54.
    Uccella S, Ghezzi F, Mariani A, Cromi A, Bogani G, Serati M, Bolis P (2011) Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol 205:119.e1–12Google Scholar
  55. 55.
    Spinoglio G, Lenti LM, Maglione V et al (2012) Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc 26:1648–1655PubMedCrossRefGoogle Scholar
  56. 56.
    Konstantinidis KM, Hirides P, Hirides S, Chrysocheris P, Georgiou M (2012) Cholecystectomy using a novel single-site(1) robotic platform: early experience from 45 consecutive cases. Surg Endosc 26:2687–2694PubMedCrossRefGoogle Scholar
  57. 57.
    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(8):709–714PubMedCrossRefGoogle Scholar
  58. 58.
    Vidal O (2009) Laparoendoscopic single-site cholecystectomy: a safe and reproducible alternative. J Laparoendosc Adv Surg Tech A 19:599–602PubMedCrossRefGoogle Scholar
  59. 59.
    Hodgett SE et al (2009) Laparoendoscopic single-site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192, 14PubMedCrossRefGoogle Scholar
  60. 60.
    Curcillo PG II et al (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860, 3PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • A. Peri
    • 1
    Email author
  • A. Vinci
    • 1
  • L. Pugliese
    • 1
  • S. Bogliolo
    • 2
  • A. Spinillo
    • 2
  • A. Pietrabissa
    • 1
  1. 1.Department of SurgeryFondazione IRCCS Policlinico San MatteoPaviaItaly
  2. 2.Department of GynecologyFondazione IRCCS Policlinico San MatteoPaviaItaly

Personalised recommendations