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.