Ann Surg Treat Res.  2019 Oct;97(4):217-221. 10.4174/astr.2019.97.4.217.

Technical feasibility of da Vinci SP single-port robotic cholecystectomy: a case report

• Cruz CJ
• Yang HY
• Kang I
• Kang CM
• Lee WJ

• KMID: 2459320
• DOI: http://doi.org/10.4174/astr.2019.97.4.217

Abstract

The da Vinci surgical system released its new pure single-port platform, the da Vinci SP, offering improvements and refinements for established robotic single-site procedures. Herein, we present the first case of robotic single-site cholecystectomy using the da Vinci SP system (RSPC) demonstrating its safety and technical feasibility. A 59-year-old female with chronic calculus cholecystitis was admitted for elective RSPC. Docking time took 6 minutes. The patient underwent successful RSPC with a total operation time of 89 minutes. There was no significant intraoperative event. The patient had unremarkable postoperative course. Multijoint instruments, simple docking process, and third-arm functionality are among the RSPC's advantages. Absence of the port for an assistant surgeon can be a hindrance in performing more complicated surgeries. The present case suggests that RSPC is safe and feasible. The promising features and potential application of da Vinci SP in hepatobiliary and pancreas surgery need further study.

Keyword

Cholecystectomy; Robotic surgery

MeSH Terms

Calculi
Cholecystectomy*
Cholecystitis
Female
Humans
Middle Aged
Pancreas

Figure

• 

  Fig. 1 Intraoperative view. Pure single port placed through a 2.5-cm umbilical incision, for accommodating 4 instruments including camera with extra orifice for assist port. Note no additional port for assist surgeon's intervention. (A) Endo-pouch and 2 gauzes were put into the abdominal cavity before robot docking (white arrow). (B) External view of the docked da Vinci SP. Three arms and one endoscope entering the single-port parallel to each other. Surgical specimen with small gallbladder stones (C), and 2.5-cm skin incision at the umbilicus (D).

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  Fig. 2 Monitor view during cholecystectomy. Left grasper controlled by nondominant left hand. Dominant right hand controls the hook. Left hand can swap to control the 3rd arm grasper by stepping on the switch control pedal for retracting gallbladder toward upward and lateral direction (A). Cystic duct isolation (B) cystic duct clipping. Note the new graphic user interface in the lower middle part of the display (magnification showed) in the surgeon console which shows the real-time relationship of 4 instruments (C). Note the effective 3rd arm movement (white arrow, D).

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  Fig. 3 (A) According to the mechanical concept of SP robotic surgical system, target lesions should be at least 15 cm apart from the entry site of single port. If the lesion is expected to be closer than this range, another port system will be required for system moving backward. (B) Maximum distance that robotic instruments can reach is estimated to be 27 cm from the outlet of single port.

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