Abstrakt Technologie Květen 2011

“The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: A systematic review.”

Ahmed, K., T. T. Wang, et al. (2011).

Surgical Endoscopy and Other Interventional Techniques 25(2): 378-396.


Objective This review aimed to determine the role of single-incision laparoscopic surgery (SILS) in abdominal and pelvic operations. Data sources The Medline, EMBASE, and PsycINFO databases were systematically searched until October 2009 using “single-incision laparoscopic surgery” and related terms as keywords. References from retrieved articles were reviewed to broaden the search Study selection The study included case reports, case series, and empirical studies that reported SILS in abdominal and pelvic operations. Data extraction Number of patients, type of instruments, operative time, blood loss, conversion rate, length of hospital stay, length of follow-up evaluation, and complications were extracted from the reviewed items Data synthesis The review included 102 studies classified as level 4 evidence. Most of these studies investigated SILS in cholecystectomy (n = 34), appendectomy (n = 24), and nephrectomy (n = 17). For these procedures, operative time, hospital stay, and complications were comparable with those of conventional laparoscopy. Conversion to conventional laparoscopy was seldom performed in cholecystectomy (range, 0-24%) and more frequent in appendectomy (range, 0-41%) and nephrectomy (range, 0-33%). Conclusion The potential benefits of SILS include superior cosmesis and possibly shorter operative time, lower costs, and a shortened time to full physical recovery. Careful case selection and a low threshold of conversion to conventional laparoscopic surgery are essential. Multicenter, randomized, prospective studies are needed to compare short-and long-term outcome measures against those of conventional laparoscopic surgery. © Springer Science+Business Media, LLC 2010.



“Transvaginal NOTES and LESS: Are They the Future in Kidney Surgery?”

Alcaraz, A., L. Peri, et al. (2011).

European Urology, Supplements 10(3): e58-e63.


Context: In the course of the development of minimally invasive surgeries over the past 20 yr, the new concept of scarless surgery has emerged. Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are included in this concept, and they are the evolution of laparoscopy towards minimising the impact of surgery on the patient. Objective: Describe our experience with NOTES and LESS in the context of the latest publications on these techniques in kidney surgery to identify their role in current urologic practice. Evidence acquisition: Over the last 3 yr, we have performed 38 transvaginally NOTES, assisted, laparoscopic nephrectomies; 16 LESS radical nephrectomies; 2 LESS partial nephrectomies; and 1 LESS live-donor nephrectomy. This paper is based on a presentation at the 2011 meeting of the European Society of Oncological Urology; a bibliographic review also was performed to make a structured paper on the most recent advances in scarless renal surgery and to describe the role NOTES and LESS currently have in urology. Evidence synthesis: NOTES is a surgical modality that uses empty organs to access the peritoneal cavity. Although pure NOTES is not available for kidney surgery yet, it eliminates abdominal scarring. The combination of NOTES with conventional laparoscopy results in a hybrid technique that maintains most of the advantages of NOTES, making it a very interesting option in kidney surgery in females. LESS concentrates all trocars and extraction incisions in one point, resulting in a small scar. It is feasible in a number of urologic procedures. Conclusions: The implementation of new minimally invasive techniques is essential to optimise surgery outcomes and improve patients’ recovery. Both hybrid NOTES and LESS have proven their feasibility in renal surgery; however, we still do not have evidence that they can overcome laparoscopic surgery; prospective trials are required to further elucidate this question. The development of minimally invasive techniques has led to the concept of scarless surgery, in which the peritoneal cavity is accessed without injuring the abdominal wall. Both natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) are surgical techniques included in this concept: they fulfill the criteria of aesthetic surgery without scarring and with minimal surgical morbidity. Despite that, the roles of NOTES and LESS, compared with conventional laparoscopy, remain to be established. © 2011 European Association of Urology.




“Robotic-assisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis.”

Barret, E., R. Sanchez-Salas, et al. (2011).

Minerva Urologica e Nefrologica 63(2): 115-122.


The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.




“Natural orifice transluminal endoscopic surgery applied to sigmoidectomy in survival animal models: Using paired magnetic intra-luminal device.”

Cho, Y. B., J. H. Park, et al. (2011).

Surgical Endoscopy and Other Interventional Techniques 25(4): 1319-1324.


Background: The clinical application of natural orifice transluminal endoscopic surgery (NOTES) for sigmoidectomy is associated with several difficulties that need to be overcome before wider clinical application of the procedure. The purpose of this study was to evaluate the technical feasibility and safety of transgastric sigmoidectomy in a survival animal model, as well as to evaluate the safety and usability of a custom paired magnetic intraluminal device, which we developed for the NOTES procedure. Methods: Survival experiments were conducted on 24-33-kg dogs. After anesthesia, a gastrotomy was created using double-channel endoscope, and peritoneoscopy was performed. The sigmoid colon was retracted laterally using paired magnetic intraluminal device, the mesocolon was dissected, and the branch vessel was sealed. The anvil was placed into the descending colon through anus. A proximal and distal colonic transection was then performed. The circular stapler was passed through the anus and performed end-to-end anastomosis. Afterwards the specimen was removed through gastrotomy, and the gastric incision was closed. Postoperatively, all dogs were recovered and monitored for well-being during convalescence. Reexploration was practiced under anesthesia 2 weeks after surgery for evaluation of intra-abdominal complications, and intra-peritoneal cultures for microorganism. Results: The mean operative time was 141 (range, 122-157) min. There were no complications or physical evidence of sepsis or bowel obstruction during the observation period. Only one dog exhibited decreased body weight, decreasing to 20.4 kg from 22.4 kg after surgery; all of the other dogs exhibited increased body weight. We observed no evidence of peritonitis, intra-abdominal abscess, bleeding, or organ injury on reexploration conducted on day 14 after surgery. Conclusions: Transgastric NOTES sigmoidectomy is a safe operation technique as evaluated in a dog model. The paired magnetic intraluminal device that was used in this study was useful to avoid an abdominal incision for retracting the sigmoid colon. © 2010 Springer Science+Business Media, LLC.




“Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments.”

Chung, S. D., C. Y. Huang, et al. (2011).

Surgical Endoscopy and Other Interventional Techniques 25(4): 1251-1256.


Background: This study aimed to evaluate laparoendoscopic single-site (LESS) adrenalectomy via the retroperitoneal approach using the Alexis wound retractor with standard laparoscopic instrumentation. Methods: Since October 2009, seven LESS retroperitoneal adrenalectomies have been completed successfully with a homemade single port created using an Alexis wound retractor as an access platform through a 3-cm incision beneath the tip of the 12th rib. Results: All the LESS procedures for these seven patients with adrenal tumors (size, 1.3-6.0 cm; 4 right, 1 left) were completed successfully without traditional laparoscopic conversion or complication. The average operative time was 159 min, and the estimated blood loss was 100 ml. The average hospital stay was 2 days (range, 1-3 days). Conclusions: The preliminary results show that LESS retroperitoneal adrenalectomy is a safe and feasible procedure for functional adrenal tumors using standard laparoscopic instruments. © 2010 Springer Science+Business Media, LLC.




“Reduced port surgery. developing a safe pathway to single port access surgery.”

Curcillo, P. G., A. S. Wu, et al. (2011).

Reduced-port-chirurgie. entwicklung eines sicheren weges zur single-port-access-chirurgie 82(5): 391-397.


“Scarfree” surgery is a desired goal in the world of laparoscopy and interventional endoscopy. One possibility to achieve this goal is abdominal access via a natural orifice (natural orifice transluminal endoscopic surgery, NOTES); however, this procedure and its applications lack an appropriate platform. Further possibilities are reduced port techniques or single port access surgery, which result in minimal scarring. Development and continued growth in this area cover a broad spectrum. Although acceptance has been demonstrated, the technique must be adopted in a safe and effective manner and must be economically and ecologically safe. This article gives an overview of the development of the technique, the learning curve, and new applications for this new technique. An English full-text version of this article is available at SpringerLink as supplemental. © Springer-Verlag 2011.




“The application of natural orifice surgery for adenocarcinoma of the prostate.”

Duty, B., O. Roy, et al. (2011).

Urologic Oncology: Seminars and Original Investigations 29(3): 330-333.


Prostate cancer remains the most common solid organ malignancy in men. Unfortunately, surgical management of this disease is often associated with significant morbidity. In an effort to decrease the invasiveness and deleterious impact on quality of life associated with prostate cancer surgery, minimally invasive techniques have been applied to this disease. At present, the robotic-assisted laparoscopic radical prostatectomy has become the most commonly performed surgical treatment modality for adenocarcinoma of the prostate. Recently, several centers within the United States have begun to evaluate the feasibility of applying natural orifice translumenal endoscopic surgery to prostate cancer. This review article details the initial work done on cadaveric and canine models to develop the transurethral radical prostatectomy procedure. Potential advantages and disadvantages of this modality, as well as challenges facing its continued development, are highlighted. © 2011 Elsevier Inc.




“Single-port access transaxillary totally endoscopic thyroidectomy: A new approach for minimally invasive thyroid operation.”

Fan, Y., S. D. Wu, et al. (2011).

Journal of Laparoendoscopic and Advanced Surgical Techniques 21(3): 243-247.


Purpose: Various techniques for minimally invasive thyroid surgery have been described over the last decade. As interest in single-port access laparoscopic surgery (SPATM) continues to grow, the authors present their technique and short-term outcomes for single-port access transaxillary totally endoscopic thyroidectomy in the management of benign thyroid tumors in a series of 4 patients. Patients and Methods: Four consecutive patients from a prospectively maintained endoscopic thyroidectomy database were analyzed under an institutional review board-approved protocol. Clinical characteristics and short-term outcomes were reviewed. Results: All the patients were young women with no prior neck surgery. A single-port totally endoscopic thyroidectomy was performed for thyroid adenoma in 2 cases and for nodular goiter in 2 cases. Retraction, exposure, and extraction were possible in all cases. The average operating room time was 92.5 minutes. Postoperative pain scores on postoperative day 1 were all 1/10. No patient experienced complications. The median hospital stay was 1.75 days. The mean specimen size was 2.7cm×2.375cm×2. 625cm. The patients were uniformly pleased with the cosmetic results of the operation. Conclusions: Single-port access transaxillary totally endoscopic partial thyroidectomy appears to be safe and feasible. This technique may provide both an attractive way to reduce injury to the anterior neck tissue and a method for ideal cosmetic effect. © Copyright 2011, Mary Ann Liebert, Inc.




“Single-incision laparoscopic liver resection.”

Gaujoux, S., T. P. Kingham, et al. (2011).

Surgical Endoscopy and Other Interventional Techniques 25(5): 1489-1494.


Background: Laparoscopic liver surgery has become a safe and effective approach to the surgical management of liver disease. Recently developed, single-port-access surgery is of growing interest in an attempt to minimize abdominal wall trauma. Various abdominal procedures have already been performed via single-port access, but to date, single-port-access surgery has never been reported for liver resection. Methods: One patient underwent laparoscopic fenestration of a giant (30-cm) right hepatic cyst. Three patients underwent left liver resection through a single port for isolated liver metastasis located in segments 3/4B, 2/3, and 3/4B, respectively, and a cirrhotic patient underwent a 4B wedge resection for hepatocellular carcinoma. Results: Each procedure was performed through a single 40-mm Gelport. No supplemental ports were required. The liver was transected using a combination of LigaSure harmonic scalpels and staplers. In one case, parenchymal transection was intraoperatively prepared by a zone of microwave ablation along the line of intended division. The total operative times for the aforementioned five patients were 140,110, 110, 120, and 55 min, respectively. The respective blood losses were 20, 50, 50, 25, and 50 ml, and the overall size of the incision was 50 mm in each case. The postoperative courses were uneventful, and each patient was discharged on postoperative day 2. Conclusion: This preliminary experience suggests the technical feasibility and safety of left liver wedge resection through single-port access in terms of intra- and postoperative results. Additional experiences are mandatory to assess the viability of this emerging technique and to expand its application to additional right liver resections. © 2010 Springer Science+Business Media, LLC.




“Complications and conversions of upper tract urological laparoendoscopic single-site surgery (LESS): Multicentre experience: Results from the NOTES Working Group.”

Irwin, B. H., J. A. Cadeddu, et al. (2011).

BJU International 107(8): 1284-1289.


OBJECTIVE • To present complications and rates of conversion from LESS to conventional laparoscopy (CL) at the time of upper tract LESS urologic procedures. PATIENTS AND METHODS • Patients undergoing LESS upper tract procedures between September, 2007 and November, 2008 (n = 125) were identified at six high-volume academic centers pioneering urologic LESS procedures. All LESS procedures were performed transperitoneally via a single umbilical incision using either adjacent conventional trocars or a dedicated single-site access device. Reconstructive procedures incorporating a single planned 2 mm accessory needle port were included as LESS procedures and were not considered conversions. • Patients, undergoing LESS procedures requiring conversion to CL with the placement of additional ports were identified. Conversion was defined as the placement of additional 5 or 10/12 mm ports beyond the primary incision. In each case the operative reports were reviewed, the reason for conversion was determined, and the number and types of additional ports and complications were noted. RESULTS • Upper tract LESS procedures were performed in 125 patients comprising 13.3% of the total 937 laparoscopic procedures performed at the participating institutions during this time period. Conversion to CL was necessary in 7 patients (5.6%) undergoing LESS requiring the addition of 2-5 ports. • Reasons for conversion included: facilitate dissection in 3 (43%), facilitate reconstruction in 3 (43%), and control of bleeding in 1 (14%). All attempted LESS cases were completed laparoscopically without need for open conversion. • Complications occurred in 15.2% of patients undergoing LESS surgery. Three of the 7 patients that required conversion to CL developed postoperative complications (Clavien grade II in two and IIIa in one). • Limitations of this study included the inability to standardize LESS patient selection criteria, instrumentation and surgical technique as well as the lack of available complete data from a CL control group for comparison. CONCLUSION • LESS surgery is technically feasible for a variety of upper urinary tract reconstructive and ablative procedures, although it appears to be associated with higher rates of complications than in mature CL series. Conversion to CL occurs infrequently and may be a reflection of stringent patient selection. © 2010 the authors. journal compilation.




“Transvaginal assisted totally laparoscopic single-port right colectomy.”

Karahasanoglu, T., I. Hamzaoglu, et al. (2011).

Journal of Laparoendoscopic and Advanced Surgical Techniques 21(3): 255-257.


Operative approach for right colectomy has progressed substantially in last decades, by the application of laparoscopy in colorectal surgery. Single-port (SP) laparoscopic surgery is one of the newest branches of advanced laparoscopy. A 29-year-old woman with ileocecal Crohn’s disease underwent a totally laparoscopic transumbilical SP right colectomy, assisted by vaginal access. The operation time was 140 minutes. The blood loss was 20mL. The patient was allowed to drink fluids and a soft oral diet on the first day postoperatively. Neither intraoperative nor postoperative complications were observed. The patient was discharged on postoperative day 4. The wound size was 2.5cm. The umbilical scar was almost invisible on postoperative day 7. Totally laparoscopic transumbilical SP right colectomy with vaginal access is a feasible procedure, providing a scarless surgery, ensuring the preservation of the body image. © Copyright 2011, Mary Ann Liebert, Inc.




“Laparoendoscopic single-site surgery in children.”

Kojima, Y., K. Mizuno, et al. (2011).

Japanese Journal of Clinical Urology 65(3): 209-213.




“Tissue Compression Analysis for Magnetically Anchored Cautery Dissector During Single-Site Laparoscopic Cholecystectomy.”

Mashaud, L. B., W. Kabbani, et al. (2011).

Journal of Gastrointestinal Surgery 15(6): 902-907.


Introduction: The purpose of this study was to evaluate the histological effects of dynamic abdominal wall compression using the magnetic anchoring and guidance system (MAGS) platform. Methods: Cholecystectomy was performed in two nonsurvival and two survival pigs using a single-site laparoscopic (SSL) approach. A deployable MAGS cautery dissector was used to perform the entire dissection in conjunction with a laparoscope and other instruments. The abdominal wall areas corresponding to the region occupied by the MAGS platform were examined grossly and microscopically for signs of tissue damage. Gallbladder dissection time was 36 min with no complications. Compressed abdominal wall thickness was 1. 4 cm. Results: In all four animals, a very mild skin erythema was noted immediately postprocedure but was nonvisible within 20 min. Mild peritoneal blanching was noted in two animals, and one animal exhibited a 5-mm area of petechiae. Necropsy demonstrated no adhesions. Light microscopy documented no evidence of tissue injury for all specimens. Discussion: This study demonstrated that the use of the MAGS cautery dissector for a SSL cholecystectomy was advantageous in providing triangulation and did not result in any significant gross or microscopic tissue damage despite the thin abdominal wall of the porcine model. © 2011 The Society for Surgery of the Alimentary Tract.




“Laparoendoscopic single-site surgery for renal tumor.”

Mimata, H. and F. Sato (2011).

Japanese Journal of Clinical Urology 65(3): 193-197.




“Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy.”

Park, J. S., G. S. Choi, et al. (2011).

British Journal of Surgery 98(5): 710-715.


Background: This case-control study compared the clinical outcomes of totally laparoscopic hemicolectomy with natural orifice specimen extraction (NOSE) and the conventional laparoscopically assisted approach for right-sided colonic cancer. Methods: Consecutive patients who underwent totally laparoscopic mobilization of the right colon with transvaginal resection, anastomosis and specimen extraction between April 2007 and December 2009 were matched by various clinicopathological characteristics with patients who had conventional laparoscopically assisted procedures. Results: Thirty-four patients in each group were studied. The number of lymph nodes harvested and the resection margin status were similar in the two groups. After NOSE, patients experienced less pain (mean(s.e.m.) pain score on day 1: 4·2(0·3) versus 5·7(0·3), P = 0·001; on day 3: 2·6(0·2) versus 3·5(0·2), P = 0·010) and had a shorter hospital stay (mean(s.d.) 7·9(0·8) versus 8·8(1·5) days; P = 0·003). The NOSE group had less surgical morbidity than the laparoscopically assisted group, but the difference was not significant (4 of 34 versus 9 of 34; P = 0·119). After a median follow-up of 23 (range 5-40) months, there was no transvaginal access-site recurrence or posterior colpotomy-related complications. NOSE was associated with significantly better cosmetic results (mean(s.d.) score 7·5(1·7) versus 6·6(1·8); P = 0·037). Conclusion: The NOSE approach is feasible with favourable short-term surgical outcomes. © 2011 British Journal of Surgery Society Ltd.




“Single-incision laparoscopic surgery (SILSTM) versus standard laparoscopic surgery: A comparison of performance using a surgical simulator.”

Santos, B. F., D. Enter, et al. (2011).

Surgical Endoscopy and Other Interventional Techniques 25(2): 483-490.


Background Single-incision laparoscopic surgery (SILSTM) is a potentially less invasive approach than standard laparoscopy (LAP). However, SILSTM may not allow the same level of manual dexterity and technical performance compared to LAP. We compared the performance of standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS) program using either the LAP or the SILSTM technique. Methods Medical students, surgical residents, and attending physicians were recruited and divided into inexperienced (IE), laparoscopy-experienced (LE), and SILSTM-experienced (SE) groups. Each subject performed standardized tasks from FLS, including peg transfer, pattern cutting, placement of ligating loop, and intracorporeal suturing using a standard three-port FLS box-trainer with standard laparoscopic instruments. For SILSTM the subjects used an FLS box-trainer modified to accept a SILS PortTM with two working ports for instruments and one port for a 30° 5-mm laparoscope. SILSTM tasks were performed with instruments capable of unilateral articulation. SILSTM suturing was performed both with and without an articulating EndoStitchTM device. Task scores, including cumulative laparoscopic FLS score (LS) and cumulative SILSTM FLS score (SS), were calculated using standard time and accuracy metrics. Results There were 27 participants in the study. SS was inferior to LS in all groups. LS increased with experience level, but was similar between LE and SE groups. SS increased with experience level and was different among all groups. SILSTM suturing using the articulating suturing device was superior to the use of a modified needle driver technique. Conclusions SILSTM is more technically challenging than standard laparoscopic surgery. Using currently available SILSTM platforms and instruments, even surgeons with SILSTM experience are unable to match their overall LAP performance. Specialized training curricula should be developed for inexperienced surgeons who wish to perform SILSTM. © Springer Science+Business Media, LLC 2010.




“Bilateral Robotic Single-Site Partial Nephrectomy.”

Seo, I. Y. and J. S. Rim (2011).

Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A.


Abstract We performed bilateral robotic single-site partial nephrectomy on a 51-year-old man with bilateral renal tumors. Left partial nephrectomy without renal arterial clamping and right partial nephrectomy with a warm ischemic time of 29 minutes were performed through a single umbilical port and one additional port. The total operative time was 350 minutes including 238 minutes of robotic console time. There were no operative complications and no open conversions. Follow-up exams over a 12-month period showed no tumor recurrence. Our report shows the technical feasibility of bilateral robotic single-site partial nephrectomy.




“Laparoendoscopic single site (LESS) radical prostatectomy:a review of the initial experience.”

Silberstein, J., N. Power, et al. (2011).

Minerva Urologica e Nefrologica 63(2): 123-129.


Surgical treatment for prostate cancer has changed dramatically in recent years due to the incorporation of minimally invasive techniques in the surgical armamentarium. Open surgical approaches to the prostate have largely given way to laparoscopic and robotic techniques. In order to further reduce incisional morbidity and improve cosmesis, there has been a recent interest in laparoendoscopic single site (LESS) approaches to the prostate. Despite a rising interest, there is little available data on these procedures. We performed a systematic review of the literature using MEDLINE, OVID, and Web of Science to identify all publications including LESS radical prostatectomy to date. Manual bibliographic review of cross-referenced items was also performed. We attempt to identify and summarize existing data on these procedures both with and without robotic assistance. Additionally, we review the emerging devices, instruments, cameras, and ports that have made these procedures possible. Next, we offer insight into how this rapidly moving field may transition in the future. Finally, we provide our commentary on this surgical approach, its impact on urology, and how it may help us evolve in the future.




“Robotic single-site surgery: Laparoscopic partial nephrectomy and ureteropelvic angioplasty in pigs.”

Yang, B., H. Q. Wang, et al. (2011).

Academic Journal of Second Military Medical University 32(4): 409-412.


Objective To make an initial attempt to use robotic single-site surgery for laparoscopic partial nephrectomy and ureteropelvic angioplasty in pigs, so as to assess the feasibility and ergonomics of the robotic single-site surgery in laparoscopic urological reconstruction surgery and to summarize the manipulation experience. Methods Partial nephrectomy: at a lateral position, a 4 cm incision was made at the level of hilum on the lateral border of the rectus muscle, and the subcutaneous tissue layer was dissected bluntly with the Kelly clamp. After pneumoperitoneum was established by the veress needle, four trocars were introduced in the shape of diamond, including two 8 mm robotic trocars on the left and right rides and two 10 mm surgiquest trocars on the upper and lower rides. After the robotic tower was docked, the procedure of nephrectomy was performed routinely. And the renal defect was closed by a horizontal mattress suture with “sliding-clip technique”. Pyeloplasty: all trocars were removed and a 4 cm long incision was made; the novel suriquest robotic port was introduced into the abdominal cavity. Two 8 mm robotic metal trocars were introduced from two sides of the surgiquest port in the way of “1 + 1″. After the robotic arm was docked, the pyeloplasty was performed. Results Partial nephrectomy were successfully performed in two cases, with the time for establishing access bring 5 min and 8 min, time for docking the robotic system bring 11 min and 9 min, time for operation bring 55 min and 42 min, and time of warm ischemia bring 23 min and 18 min, and with the blood loss bring 50 ml and 20 ml. Pyeloplasty were successfully performed in two cases, with the time for establishing access bring 17 min and 12 min, time for docking the robotic system bring 5 min and 4 min, and time of operation bring 32 min and 25 min, andwith no blood loss. Conclusion After proper setup of trocars, the roboic single-site operation under laparoscope can complete the complex urological reconstructive surgery. And the novel surgiquest port can obtain more ideal ergonomics outcomes.




“Surgical robotics and instrumentation.”


Int J Comput Assist Radiol Surg.




“Evaluation of fetal tissue viscoelastic characteristics for robotic fetal surgery.”

Harada, K., S. Enosawa, et al. (2011).

International Journal of Computer Assisted Radiology and Surgery: 1-6.


Purpose: Minimally invasive fetal surgery is expected to improve therapeutic outcomes, and surgical robots are expected to aid the dexterous manipulation of fragile fetal tissues. Although robots are currently used for surgery on soft tissues, practical information concerning the viscoelastic characteristics of fetal tissues is lacking. Hence, the mechanical properties of fetal tissues should be quantified to design robotic devices that facilitate computer-assisted fetal surgery. Methods: Shear creep tests were performed on abdominal wall tissues of rat fetuses, aged 16-20 days, and on the brain, lung, and liver tissues of adult rats. Viscoelastic properties of these tissues were evaluated using a rheometer. Histological sections of fetal rat tissues were stained with hematoxylin and eosin. Results: The viscoelastic properties of fetal tissues were quantified using models. Fetal tissues displayed 2 distinct phases of fragility, i.e., gelatinous characteristics with a markedly lower viscoelasticity before day 18 than after day 19. Concomitantly, skin morphology matured remarkably after day 19. As judged by the morphology, the gestation age of 19 days in rats corresponds to that of 23 weeks in human fetuses. From our data, we prepared artificial phantoms; phantoms made from 1.0% gelatin showed mechanical properties very similar to those of the fetuses before day 18. Conclusion: We observed unique mechanical characteristics in fetal tissue, a previously unknown target for surgical robots. From the data obtained, we produced phantoms that have similar viscoelastic properties, aiming at designing surgical robots capable of handling early fetuses. © 2011 CARS.