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Laparo-endoscopic single-site surgery: recent advances in urology.

Autorino R, Sosnowski R, De Sio M, Simone O, Khalifeh A, Kaouk JH - Cent European J Urol (2012)

Bottom Line: Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time.Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria.Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.

View Article: PubMed Central - PubMed

Affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA ; Service of Urology, Second University of Naples, Napoli, Italy.

ABSTRACT
Significant advances have been achieved in the field of urologic laparo-endoscopic single-site surgery (LESS) since the first reported clinical series in 2007. The aim of the present review paper is to summarize and critically analyze the most recent advances in the field of urologic LESS. A literature review was performed using PubMed to retrieve publications related to LESS in urology over the last two years (from January 2011 to May 2012). In the free-text protocol, the following terms were applied: LESS; single port laparoscopy; single incision laparoscopy. Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time. Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria. The recent introduction of a purpose-built instrumentation is likely to further foster the application of robotics to LESS. Further improvements are needed before this technique might reach a widespread adoption. Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.

No MeSH data available.


da Vinci Single Site® surgery instrumentation (Intuitive Surgical).
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Figure 0003: da Vinci Single Site® surgery instrumentation (Intuitive Surgical).

Mentions: Intuitive Surgical developed a novel set of single-site instruments and accessories specifically dedicated to LESS (Fig. 3). The set includes a multichannel access port with room for four cannulae and an insufflation valve. Two curved cannulae are for robotically controlled instruments. The other two cannulae are straight; one is 8.5mm and accommodates the high-definition and 3-dimensional endoscope and the other is a 5-mm bedside-assistant surgeon port. Triangulation is achieved by crossing the curved cannulae midway through the access port. Same-sided hand-eye-control of the instruments is maintained through the use of software, the Si system, that enables the surgeon's right hand to control the screen-right instrument even though the instrument is in the left robotic arm and reciprocally the left hand controls the screen-left instrument even though the instrument is in the right robotic arm. The second part of the platform is a set of semi-rigid, non-wristed instruments based with standard da Vinci instrument tips. The semi-rigid flexible shaft allows for insertion down the curved cannula and triangulation of the anatomy. Robotic arm collisions are minimized externally because the curved cannulae angle the robotic arms away from each other. Internal collisions with the camera are avoided because the camera is designed to be placed into the middle of the curved cannula zone and is not in a parallel arrangement. The Intuitive Surgical single-port instruments and accessories are intended to be used with the da Vinci® Si Surgical System. The single-site instruments and accessories are of similar construction to existing EndoWrist® instruments, except they do not have a wrist at the distal end of the instrument.


Laparo-endoscopic single-site surgery: recent advances in urology.

Autorino R, Sosnowski R, De Sio M, Simone O, Khalifeh A, Kaouk JH - Cent European J Urol (2012)

da Vinci Single Site® surgery instrumentation (Intuitive Surgical).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921815&req=5

Figure 0003: da Vinci Single Site® surgery instrumentation (Intuitive Surgical).
Mentions: Intuitive Surgical developed a novel set of single-site instruments and accessories specifically dedicated to LESS (Fig. 3). The set includes a multichannel access port with room for four cannulae and an insufflation valve. Two curved cannulae are for robotically controlled instruments. The other two cannulae are straight; one is 8.5mm and accommodates the high-definition and 3-dimensional endoscope and the other is a 5-mm bedside-assistant surgeon port. Triangulation is achieved by crossing the curved cannulae midway through the access port. Same-sided hand-eye-control of the instruments is maintained through the use of software, the Si system, that enables the surgeon's right hand to control the screen-right instrument even though the instrument is in the left robotic arm and reciprocally the left hand controls the screen-left instrument even though the instrument is in the right robotic arm. The second part of the platform is a set of semi-rigid, non-wristed instruments based with standard da Vinci instrument tips. The semi-rigid flexible shaft allows for insertion down the curved cannula and triangulation of the anatomy. Robotic arm collisions are minimized externally because the curved cannulae angle the robotic arms away from each other. Internal collisions with the camera are avoided because the camera is designed to be placed into the middle of the curved cannula zone and is not in a parallel arrangement. The Intuitive Surgical single-port instruments and accessories are intended to be used with the da Vinci® Si Surgical System. The single-site instruments and accessories are of similar construction to existing EndoWrist® instruments, except they do not have a wrist at the distal end of the instrument.

Bottom Line: Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time.Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria.Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.

View Article: PubMed Central - PubMed

Affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA ; Service of Urology, Second University of Naples, Napoli, Italy.

ABSTRACT
Significant advances have been achieved in the field of urologic laparo-endoscopic single-site surgery (LESS) since the first reported clinical series in 2007. The aim of the present review paper is to summarize and critically analyze the most recent advances in the field of urologic LESS. A literature review was performed using PubMed to retrieve publications related to LESS in urology over the last two years (from January 2011 to May 2012). In the free-text protocol, the following terms were applied: LESS; single port laparoscopy; single incision laparoscopy. Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time. Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria. The recent introduction of a purpose-built instrumentation is likely to further foster the application of robotics to LESS. Further improvements are needed before this technique might reach a widespread adoption. Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.

No MeSH data available.