Laparoendoscopic single-site surgery (LESS) allows for the performance of major urologic
procedures with a single small incision and minimal scarring. The da Vinci Surgical
System provides advantages of easy articulation and improved ergonomics; however,
an ideal platform for these procedures has not been identified.
To evaluate the GelPort laparoscopic system as an access platform for robotic LESS
Since April 2008, 11 R-LESS procedures have been completed successfully in a single
institutional referral center. For the last four consecutive cases, the GelPort has
been used as an access platform through a 2.5-5-cm umbilical incision.
R-LESS cases performed with the GelPort included pyeloplasty (n=2), radical nephrectomy
(n=1), and partial nephrectomy (n=1).
Perioperative data were obtained for all patients including demographic data, operative
indications, operative records, length of stay, complications, and pathologic analysis.
For both pyeloplasty cases, average operative time (OR time) was 235 min and estimated
blood loss (EBL) was 38 cm(3). For the patient undergoing radical nephrectomy for
a 5.1-cm renal tumor, OR time was 200 min and EBL was 250 cm(3). The final patient
underwent partial nephrectomy without renal hilar clamping for an 11-cm angiomyolipoma
with OR time of 180 min and EBL of 600 cm(3). All R-LESS procedures attempted with
the GelPort were completed successfully and without complication. Average length of
hospital stay was 1.75 d (range: 1-2). The partial nephrectomy patient required transfusion
of 1 U of packed red blood cells.
Use of the GelPort as an access platform for R-LESS procedures provides adequate spacing
and flexibility of port placement and acceptable access to the surgical field for
the assistant, especially during procedures that require a specimen extraction incision.
Additional platform and instrumentation development will likely simplify R-LESS procedures
further as experience grows.