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      Da Vinci single site© surgical platform in clinical practice: a systematic review : Da Vinci single site© surgical platform in clinical practice

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          Robotic single-port transumbilical surgery in humans: initial report.

          To describe our initial clinical experience of robotic single-port (RSP) surgery. The da Vinci S robot (Intuitive, Sunnyvale, CA, USA) was used to perform radical prostatectomy (RP), dismembered pyeloplasty, and radical nephrectomy. A robot 12-mm scope and 5-mm robotic grasper were introduced through a multichannel single port (R-port, Advanced Surgical Concepts, Dublin, Ireland). An additional 5-mm or 8-mm robotic port was introduced through the same umbilical incision (2 cm) alongside the multichannel port and used to introduce robotic instruments. Vesico-urethral anastomosis and pelvi-ureteric anastomosis were successfully performed robotically using running intracorporeal suturing. All three RSP surgeries were performed through the single incision without adding extra umbilical ports or 2-mm instruments. For RP, the operative duration was 5 h and the estimated blood loss was 250 mL. The hospital stay was 36 h and the margins of resection were negative. For pyeloplasty, the operative duration was 4.5 h, and the hospital stay was 50 h. Right radical nephrectomy for a 5.5-cm renal cell carcinoma was performed in 2.5 h and the hospital stay was 48 h. The specimen was extracted intact within an entrapment bag through the umbilical incision. There were no intraoperative or postoperative complications. At 1 week after surgery, all patients had minimal pain with a visual analogue score of 0/10. Technical challenges of single-port surgery that may limit its widespread acceptance can be addressed by using robotic technology. Articulation of robotic instruments may render obsolete the long-held laparoscopic principles of triangulation especially for intracorporeal suturing. We report the initial series of robotic surgery through a single transumbilical incision.
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            Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases.

            Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. To report a large multi-institutional worldwide series of LESS in urology. Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160±93 min and estimated blood loss was 148±234 ml. Skin incision length at closure was 3.5±1.5 cm. Mean hospital stay was 3.6±2.7 d with a visual analog pain score at discharge of 1.5±1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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              A novel robotic system for single-port urologic surgery: first clinical investigation.

              The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery.
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                Author and article information

                Journal
                The International Journal of Medical Robotics and Computer Assisted Surgery
                Int J Med Robotics Comput Assist Surg
                Wiley
                14785951
                December 2016
                December 2016
                November 03 2015
                : 12
                : 4
                : 724-734
                Affiliations
                [1 ]General Surgery Department of Oncology, Transplantation and New Technologies; University of Pisa; Pisa Italy
                [2 ]EndoCAS (Center for Computer Assisted Surgery); University of Pisa; Pisa Italy
                Article
                10.1002/rcs.1713
                © 2015

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