Single‐site robots

Robotic technology was first reported to have been incorporated with single‐site surgery in 2011 using the da Vinci Single‐Site^© surgical platform (Intuitive Surgical, Sunnyvale, CA, USA), which aimed to improve the technical limitations of laparoscopic single‐site surgery including external clashes, poor visualization of critical structures, and surgeon fatigue [1]. In 2015 a systematic review showed that the da Vinci surgical platform had proven to be a valuable asset in single‐site surgery, owing to the combination of robot use and dedicated single incision; the main reported limitation was the lack of an EndoWrist [2].

The da Vinci single port (SP) is Intuitive Surgical’s new surgical platform for single‐incision surgery, and gained US Food and Drug Administration approval in early 2014. It is composed of a three‐dimensional (3D) high‐definition (HD) camera and three fully articulated instruments, all in a 25 mm port. The fully wristed EndoWrist SP instruments have two more degrees of freedom than the da Vinci Single‐Site instruments. The surgeon controls the instruments and the endoscope while seated at the da Vinci Surgical System console. Intuitive Surgical plans not to release it onto the market until it has been made fully compatible with the latest da Vinci Xi robot. This will require product refinements, supply chain optimization, and additional regulatory clearances [3]. The system is designed for urologic minimally invasive procedures that are already performed via a single incision. Major urologic procedures have been successfully completed using the da Vinci SP without conversions [4].

A second single‐port system is called Single Port Orifice Robotic Technology (SPORT™; Titan Medical, Toronto, ON, Canada; see Figures 74.1 and 74.2). The system utilizes a 25 mm single‐access port which contains a 3D HD vision system and interactive multi‐articulating instruments, and a highly ergonomic surgeon workstation that provides the surgeon with an interface to the robotic platform, as well as a 3D endoscopic view inside the patient’s body cavity during minimal invasive surgical procedures. It is expected to be commercially available in late 2019. The first targets of the SPORT system are gynecologic, gastrointestinal, and urologic procedures [5].

In December 2015 the building of the first SPORT Surgical Systems to include both the work station and the patient cart was announced. These will undergo extensive testing as a part of engineering verification (EV). These two EV systems will be tested to measure performance in relation to design specifications and to measure compliance with regulatory guidelines. These EV systems were precursors of the systems that were made ready in early 2016 for the first in‐human trials. The multi‐articulating, interactive, snake‐like instruments are designed to couple with removable and sterile single‐patient‐use robotic tools that provide first‐use quality in every case and eliminate the need for instrument reprocessing. The use of reposable (re‐usable for a specific number of uses) robotic instruments and single‐patient‐use tools allows more use cases for each robotic instrument, thus reducing the per‐case cost. The robotic platform is also designed to include a mast, a boom, and wheels for optimal configurability for a variety of surgical indications and the ability to be maneuvered around the operating room and surgical centers where applicable [5].

Another single‐port robot is the SurgiBot (TransEnterix, Morrisville, NC, USA; Figures 74.3 and 74.4). It enhances laparoscopic surgery through robotic assistance, while allowing the surgeon to remain in the sterile field, at the patient’s side. It is composed of an integrated 3D HD camera for HD images with depth perception and delivers up to three articulating instruments through a single incision. One of its main advantages is that it has minimal reliance on surgical assistants and staff [6].

The Avicenna roboflex flexible uretroscopy robot (Elmed, Turkey) consists of a console and a manipulator. The hand piece of the scope is locked to the robotic arm. The surgeon at the console can control two joysticks to manipulate the rotation, deflection, and in‐and‐out movements of the endoscope. A central wheel enables fine tuning of deflection inside the collection system. The surgeon can rotate robotically 440°. This minimizes the torsion risk of the endoscope. Laser fiber can be remotely moved in and out which is very helpful for providing a suitable distance between the stone and the tip of the laser fiber. Software prevents firing of the laser shot when the laser tip is very close to the endoscope to prevent damage. The integrated water pump can also be adjusted remotely. In this way it is possible to treat a stone with a minimal flow rate and to provide low‐pressure lithotripsy [7]. A human trail on 81 patients showed efficacy, safety, and a significant improvement in ergonomics [8].

Related posts:

1: Perioperative Considerations Radiation Safety During Diagnosis and Treatment Cryotherapy of the Prostate Management of Urolithiasis in Pregnancy Patient Preparation and Operating Room Setup for Laparoscopic and Robotic Surgery Pelvic Lymphadenectomy

Stay updated, free articles. Join our Telegram channel

Join