EURURO Vol. 71 No. 4

643 692

Surgery in Motion
Robotic Laparoendoscopic Single-site Retroperitioneal Renal
Surgery: Initial Investigation of a Purpose-built Single-port
Surgical System
Matthew J. Maurice, Daniel Ramirez, Jihad H. Kaouk
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Article info
Article history:
Accepted June 6, 2016
Associate Editor:
Alexandre Mottrie
Keywords:
Laparoendoscopic single site
Nephrectomy
Renal cell carcinoma
Robotics
Robotic surgical procedures
Single site
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Abstract
Background: Robotic single-site retroperitoneal renal surgery has the potential to
minimize the morbidity of standard transperitoneal and multiport approaches. Tradi-
tionally, 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 purpose-
built 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 laparoendo-
scopic 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 complica-
tions, and operative times.
Results and limitations: All cases were 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-gen-
eration 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 success-
fully perform major surgery on the kidney through a single small incision without
entering the abdomen.
# 2016 Published by Elsevier B.V. on behalf of European Association of Urology.
* Corresponding author. Department of Urology, Glickman Urological and Kidney Institute, Cleveland
Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel. +1 216 4442976; Fax: +1 216 6364492.
E-mail address: (J.H. Kaouk).
0302-2838/# 2016 Published by Elsevier B.V. on behalf of European Association of Urology.