Robotic Laparoendoscopic Single-site Retroperitioneal Renal Surgery: Initial Investigation of a Purpose-built Single-port Surgical System

Background: Robotic single-site retroperitoneal renal surgery has the potential to minimize the morbidity of standard transperitoneal and multiport approaches. Traditionally, technological limitations of non-purpose-built robotic platforms have hindered the application of this approach. Objective: To assess the feasibility of retroperitoneal renal surgery using a new purposebuilt robotic single-port surgical system. Design, setting, and participants: This was a preclinical study using three male cadavers to assess the feasibility of the da Vinci SP1098 surgical system for robotic laparoendoscopic single-site (R-LESS) retroperitoneal renal surgery. Surgical procedure: We used the SP1098 to perform retroperitoneal R-LESS radical nephrectomy (n = 1) and bilateral partial nephrectomy (n = 4) on the anterior and posterior surfaces of the kidney. Improvements unique to this system include enhanced optics and intelligent instrument arm control. Access was obtained 2 cm anterior and inferior to the tip of the 12th rib using a novel 2.5-cm robotic single-port system that accommodates three double-jointed articulating robotic instruments, an articulating camera, and an assistant port. Measurements: The primary outcome was the technical feasibility of the procedures, as measured by the need for conversion to standard techniques, intraoperative complications, and operative times. Results and limitations: All caseswere completed without the need for conversion. There were no intraoperative complications. The operative time was 100 min for radical nephrectomy, and the mean operative time was 91.8 +/- 18.5 min for partial nephrectomy. Limitations include the preclinical model, the small sample size, and the lack of a control group. Conclusions: Single-site retroperitoneal renal surgery is feasible using the latest-generation SP1098 robotic platform. While the potential of the SP1098 appears promising, further study is needed for clinical evaluation of this investigational technology. Patient summary: In an experimental model, we used a new robotic system to successfully perform major surgery on the kidney through a single small incision without entering the abdomen. (C) 2016 Published by Elsevier B.V. on behalf of European Association of Urology.