Investig Clin Urol.  2019 Jul;60(4):326-330. 10.4111/icu.2019.60.4.326.

Pure single-site robot-assisted pyeloplasty with the da Vinci SP surgical system: Initial experience

• Heo JE
• Kang SK
• Koh DH
• Na JC
• Lee YS
• Han WK
• Choi YD
• Jang WS

• KMID: 2450551
• DOI: http://doi.org/10.4111/icu.2019.60.4.326

Abstract

PURPOSE
Laparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy while providing superior cosmetic results. However, LESS remains a challenging surgical technique, even in robotic surgery, primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP surgical system (Intuitive Surgical) was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the da Vinci SP surgical system.
MATERIALS AND METHODS
Three consecutive patients who were diagnosed with UPJO underwent RAP with the da Vinci SP surgical system from December 2018 to February 2019 at our institution. The surgical technique involved reproducing the steps of multi-port RAP. A 30-mm umbilical incision was made and the GelPOINT was inserted. The multichannel robotic port and the assistant's port were placed through the GelSeal cap. In all patients, Anderson-Hynes dismembered pyeloplasty was performed. The ureteral double J stent was inserted antegrade, and the drain was not placed.
RESULTS
The procedures were successfully completed using a pure single-site approach. There was no need for additional port placement or conversion to laparoscopic or open surgery. Total operative time in the three patients was 139, 180, and 213 minutes, respectively. No intraoperative complications occurred, and blood loss was minimal. The postoperative course of all patients was uneventful with no complications greater than Clavien-Dindo grade I surgical complications.
CONCLUSIONS
Pure single-site RAP using the da Vinci SP surgical system is feasible and safe.

Keyword

Laparoscopy; Robotic surgical procedures; Ureteral obstruction

MeSH Terms

Humans
Intraoperative Complications
Laparoscopy
Operative Time
Robotic Surgical Procedures
Stents
Ureter
Ureteral Obstruction

Figure

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  Fig. 1 Placement of the GelPOINT advanced access platform. A 25-mm multichannel port and a 12-mm assistant port were placed through the GelSeal cap.

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  Fig. 2 Placement of the instruments and docked single-port platform.

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  Fig. 3 Cosmetic result after skin closure.

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