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

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Abstract

Background

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.

Methods

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.

Results

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 %.

Conclusions

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.

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References

  1. NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269:1018–1024

    Article  Google Scholar 

  2. Allen JW, Rivas H, Cocchione RN, Ferzli GS (2003) Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy. JSLS 7:137–140

    PubMed  Google Scholar 

  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 210:436–440

    Article  PubMed  Google Scholar 

  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 26:2711–2716

    Article  PubMed  Google Scholar 

  5. Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery—current status and controversies. J Minim Access Surg 7:6–16

    PubMed  Google Scholar 

  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 26:714–721

    Article  PubMed  Google Scholar 

  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 18:500–502

    Article  PubMed  Google Scholar 

  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 146:1122–1127

    Article  PubMed  Google Scholar 

  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 8:191–195

    Article  PubMed  Google Scholar 

  10. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

    Article  PubMed  CAS  Google Scholar 

  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 24:762–768

    Article  PubMed  Google Scholar 

  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 24:1854–1860

    Article  PubMed  Google Scholar 

  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 256:909–914

    Article  PubMed  Google Scholar 

  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 26:1296–1303

    Article  PubMed  Google Scholar 

  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 212:113–118

    Article  PubMed  Google Scholar 

  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 19:344–349

    Article  PubMed  Google Scholar 

  17. Park YH, Balk KD, Lee YJ, Kim KT, Kim HH (2012) Learning curve analysis for laparoendoscopic single-site radical nephrectomy. J Endourol 26:494–498

    Article  PubMed  Google Scholar 

  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 203:327–329

    Article  PubMed  Google Scholar 

  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 13:159–162

    Article  PubMed  Google Scholar 

  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 147:709–714

    Article  PubMed  Google Scholar 

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Disclosures

Dr. Lau is on the medical advisory board for Miret Surgical. Dr. Rivas is a consultant for Covidien. Drs. Eisenberg, Vidovszky, Lau, Guiroy, and Rivas received an honorarium for participation in this study from Intuitive Surgical, Inc.

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Authors and Affiliations

  1. Department of Surgery, Stanford School of Medicine, 300 Pasteur Drive, Stanford, CA, USA

    Dan Eisenberg, James Lau & Homero Rivas

  2. Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA

    Dan Eisenberg

  3. Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA

    Tamas J. Vidovszky

  4. Department of Surgery, Salinas Memorial Hospital, Salinas, CA, USA

    Bernadette Guiroy

Authors
  1. Dan Eisenberg
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  2. Tamas J. Vidovszky
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  3. James Lau
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  4. Bernadette Guiroy
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  5. Homero Rivas
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Corresponding author

Correspondence to Dan Eisenberg.

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Eisenberg, D., Vidovszky, T.J., Lau, J. et al. Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task. Surg Endosc 27, 3182–3186 (2013). https://doi.org/10.1007/s00464-013-2874-y

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  • DOI: https://doi.org/10.1007/s00464-013-2874-y

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