Advertisement

Robotic Single-Port Platform in General, Urologic, and Gynecologic Surgeries: A Systematic Review of the Literature and Meta-analysis

  • S. CianciEmail author
  • A. Rosati
  • V. Rumolo
  • S. Gueli Alletti
  • V. Gallotta
  • L. C. Turco
  • G. Corrado
  • G. Vizzielli
  • A. Fagotti
  • F. Fanfani
  • G. Scambia
  • S. Uccella
Scientific Review

Abstract

Background

Robotic platforms have recently acquired progressive importance in different surgical fields, such as urology, gynecology, and general surgery. Through the years, new surgical robots have become available as single-port robotic platform. The study is aimed to value the single-port robotic platform characteristics in different surgical specialties.

Methods

The terms “LESS” OR “single port” OR “single site” AND “robot” OR “robotic” were systematically used to search the PubMed and Scopus databases. A total of 57 studies were considered eligible for the present review. The articles included were divided according to the surgical field in which the study was conducted: General surgery (29 articles), Gynecology (18 articles), Urology (10 articles).

Results

Most part of the articles showed the feasibility of robotic single-port surgical procedures and described advantages in terms of cosmetic, hospital stay, and in some series even cost reduction. A meta-analysis was conducted, showing a significant increment of complications using RSP if compared with SLPS and a trend (P = 0.008) when RSP was compared with LESS. The comparison of different techniques in terms of conversion to laparotomy did not show any significant difference.

Conclusion

Robotic single port potentially furnishes an important surgical and post-operatory improvement; however, some limits still prolong the surgical time and complication rate.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Gueli Alletti S, Vizzielli G, Lafuenti L, Costantini B, Fagotti A, Fedele C, Cianci S, Perrone E, Gallotta V, Rossitto C, Scambia G (2018) Single-institution propensity-matched study to evaluate the psychological effect of minimally invasive interval debulking surgery versus standard laparotomic treatment: from body to mind and back. J Minim Invasive Gynecol 25:816–822Google Scholar
  2. 2.
    Rossitto C, Gueli Alletti S, Cianci S, Perrone E, Scambia G (2017) Reply. J Minim Invasive Gynecol 24(4):683–684Google Scholar
  3. 3.
    Gueli Alletti S, Rossitto C, Perrone E, Cianci S, De Blasis I, Fagotti A et al (2016) Needleoscopic conservative staging of borderline ovarian tumor. J Minim Invasive Gynecol 16:31151–31157.  https://doi.org/10.1016/j.jmig.2016.10.009 Google Scholar
  4. 4.
    Rossitto C, Gueli Alletti S, Rotolo S, Cianci S, Panico G, Scambia G (2016) Total laparoscopic hysterectomy using a percutaneous surgical system: a pilot study towards scarless surgery. Eur J Obstet Gynecol Reprod Biol 203:132–135Google Scholar
  5. 5.
    Uccella S, Cromi A, Casarin J, Bogani G, Serati M, Gisone B, Pinelli C, Fasola M, Ghezzi F (2015) Minilaparoscopic versus standard laparoscopic hysterectomy for uteri ≥ 16 weeks of gestation: surgical outcomes, postoperative quality of life, and cosmesis. J Laparoendosc Adv Surg Tech A 25(5):386–391Google Scholar
  6. 6.
    Cosentino F, Vizzielli G, Turco LC, Fagotti A, Cianci S, Vargiu V, Zannoni GF, Ferrandina G, Scambia G (2018) Near-infrared imaging with indocyanine green for detection of endometriosis lesions (Gre-Endo Trial): a pilot study. J Minim Invasive Gynecol 25:1249–1254Google Scholar
  7. 7.
    Gallotta V, Conte C, Giudice MT, Nero C, Vizzielli G, Gueli Alletti S, Cianci S, Lodoli C, Di Giorgio A, De Rose AM, Fagotti A, Scambia G, Ferrandina G (2018) Secondary laparoscopic cytoreduction in recurrent ovarian cancer: a large, single-institution experience. J Minim Invasive Gynecol 25(4):644–650Google Scholar
  8. 8.
    Uccella S, Buda A, Morosi C, Di Martino G, Delle Marchette M, Reato C, Casarin J, Ghezzi F (2018) Minilaparoscopy vs standard laparoscopy for sentinel node dissection: a pilot study. J Minim Invasive Gynecol 25(3):461.e1–466.e1Google Scholar
  9. 9.
    Wakasugi M, Tanemura M, Furukawa K, Tei M, Suzuki Y, Masuzawa T, Kishi K, Akamatsu H (2017) Feasibility and safety of single-incision laparoscopic cholecystectomy in elderly patients: a singleinstitution, retrospective case series. Ann Med Surg (Lond) 6(22):30–33Google Scholar
  10. 10.
    Rossitto C, Cianci S, Gueli Alletti S, Perrone E, Pizzacalla S, Scambia G (2017) Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery. Eur J Obstet Gynecol Reprod Biol 216:125–129Google Scholar
  11. 11.
    Ghezzi F, Serati M, Casarin J, Uccella S (2015) Minilaparoscopic single-site total hysterectomy. Obstet Gynecol 126(1):151–154Google Scholar
  12. 12.
    Gueli Alletti S, Rossitto C, Cianci S, Restaino S, Costantini B, Fanfani F, Fagotti A, Cosentino F, Scambia G (2016) Telelap ALF-X vs standard laparoscopy for the treatment of early-stage endometrial cancer: a single-institution retrospective cohort study. J Minim Invasive Gynecol 23(3):378–383Google Scholar
  13. 13.
    Gueli Alletti S, Rossitto C, Cianci S, Scambia G (2016) Telelap ALF-X total hysterectomy for early stage endometrial cancer: new frontier of robotic gynecological surgery. Gynecol Oncol 140(3):575–576Google Scholar
  14. 14.
    Gueli Alletti S, Rossitto C, Cianci S, Perrone E, Pizzacalla S, Monterossi G, Vizzielli G, Gidaro S, Scambia G (2018) The Senhance™ surgical robotic system (“Senhance”) for total hysterectomy in obese patients: a pilot study. J Robot Surg. 12:229–234Google Scholar
  15. 15.
    Gueli Alletti S, Perrone E, Cianci S, Rossitto C, Monterossi G, Bernardini F, Scambia G (2018) 3 mm Senhance robotic hysterectomy: a step towards future perspectives. J Robot Surg 12:575–577Google Scholar
  16. 16.
    Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 349:g7647Google Scholar
  17. 17.
    Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926Google Scholar
  18. 18.
    Balachandran B, Hufford TA, Mustafa T, Kochar K, Sulo S, Khorsand J (2017) A comparative study of outcomes between single-site robotic and multi-port laparoscopic cholecystectomy: an experience from a Tertiary Care Center. World J Surg 41(5):1246–1253.  https://doi.org/10.1007/s00268-016-3799-0 Google Scholar
  19. 19.
    Rosales-Velderrain A, Alkhoury F (2017) Single-port robotic cholecystectomy in pediatric patients: single institution experience. J Laparoendosc Adv Surg Tech A 27(4):434–437Google Scholar
  20. 20.
    Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, Tiesenga FM, Konstantinidis K, Hirides P, Mehendale S, Gonzalez A (2017) Cosmesis, patient satisfaction, and quality of life after da vinci single-site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc 31(8):3242–3250Google Scholar
  21. 21.
    van der Linden YT, Brenkman HJ, van der Horst S, van Grevenstein WM, van Hillegersberg R, Ruurda JP (2016) Robotic single-port laparoscopic cholecystectomy is safe but faces technical challenges. J Laparoendosc Adv Surg Tech A 26(11):857–861Google Scholar
  22. 22.
    Pietrabissa A, Pugliese L, Vinci A, Peri A, Tinozzi FP, Cavazzi E, Pellegrino E, Klersy C (2016) Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc 30(7):3089–3097Google Scholar
  23. 23.
    Jung MJ, Lee SY, Lee SH, Kang CM, Lee WJ (2015) Single-site robotic cholecystectomy: reverse-port technique. Medicine (Baltimore) 94(42):e1871Google Scholar
  24. 24.
    Lee GS, Arghami A, Dy BM, McKenzie TJ, Thompson GB, Richards ML (2016) Robotic single-site adrenalectomy. Surg Endosc 30(8):3351–3356Google Scholar
  25. 25.
    Jones VS (2015) Robotic-assisted single-site cholecystectomy in children. J Pediatr Surg 50(11):1842–1845Google Scholar
  26. 26.
    Arghami A, Dy BM, Bingener J, Osborn J, Richards ML (2015) Single-port robotic-assisted adrenalectomy: feasibility, safety, and cost-effectiveness. JSLS 19(1):e2014.00218Google Scholar
  27. 27.
    Ayloo S, Choudhury N (2014) Single-site robotic cholecystectomy. JSLS 18(3).  https://doi.org/10.4293/JSLS.2014.00266
  28. 28.
    Juo YY, Agarwal S, Luka S, Satey S, Obias V (2015) Single-Incision Robotic Colectomy (SIRC) case series: initial experience at a single center. Surg Endosc 29(7):1976–1981Google Scholar
  29. 29.
    Uras C, Böler DE, Ergüner I, Hamzaoğlu I (2014) Robotic single port cholecystectomy (R-LESS-C): experience in 36 patients. Asian J Surg 37(3):115–119Google Scholar
  30. 30.
    Lim MS, Melich G, Min BS (2013) Robotic single-incision anterior resection for sigmoid colon cancer: access port creation and operative technique. Surg Endosc 27(3):1021Google Scholar
  31. 31.
    Pietrabissa A, Sbrana F, Morelli L, Badessi F, Pugliese L, Vinci A, Klersy C, Spinoglio G (2012) Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology. Arch Surg 147(8):709–714Google Scholar
  32. 32.
    Konstantinidis KM, Hirides P, Hirides S, Chrysocheris P, Georgiou M (2012) Cholecystectomy using a novel Single-Site robotic platform: early experience from 45 consecutive cases. Surg Endosc 26(9):2687–2694Google Scholar
  33. 33.
    Morel P, Hagen ME, Bucher P, Buchs NC, Pugin F (2011) Robotic single-port cholecystectomy using a new platform: initial clinical experience. J Gastrointest Surg 15(12):2182–2186Google Scholar
  34. 34.
    Wren SM, Curet MJ (2011) Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg 146(10):1122–1127Google Scholar
  35. 35.
    Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P, Kaouk J, Chalikonda S (2011) First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc 25(11):3566–3573Google Scholar
  36. 36.
    Mattei P (2018) Single-site robotic-assisted laparoscopic cholecystectomy in children and adolescents: a report of 20 cases. Surg Endosc 32(5):2402–2408Google Scholar
  37. 37.
    Lim C, Bou Nassif G, Lahat E, Hayek M, Osseis M, Gomez-Gavara C, Moussalem T, Azoulay D, Salloum C (2017) Single-incision robotic cholecystectomy is associated with a high rate of trocar-site infection. Int J Med Robot 13(4):e1856Google Scholar
  38. 38.
    Lee H, Lee DH, Kim H, Han Y, Kim SW, Jang JY (2017) Single-incision robotic cholecystectomy: a special emphasis on utilization of transparent glove ports to overcome limitations of single-site port. Int J Med Robot 13(3):e1789Google Scholar
  39. 39.
    Su WL, Huang JW, Wang SN, Lee KT (2017) Comparison study of clinical outcomes between single-site robotic cholecystectomy and single incision laparoscopic cholecystectomy. Asian J Surg 40(6):424–428Google Scholar
  40. 40.
    Gonzalez A, Murcia CH, Romero R, Escobar E, Garcia P, Walker G, Gallas M, Dickens E, McIntosh B, Norwood W, Kim K, Rabaza J, Parris D (2016) A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 30(7):2951–2960Google Scholar
  41. 41.
    Svoboda S, Qaqish TR, Wilson A, Park H, Youssef Y (2015) Robotic single-site cholecystectomy in the obese: outcomes from a single institution. Surg Obes Relat Dis 11(4):882–885Google Scholar
  42. 42.
    Morel P, Buchs NC, Iranmanesh P, Pugin F, Buehler L, Azagury DE, Jung M, Volonte F, Hagen ME (2014) Robotic single-site cholecystectomy. J Hepatobiliary Pancreat Sci 21(1):18–25Google Scholar
  43. 43.
    Gonzalez AM, Rabaza JR, Donkor C, Romero RJ, Kosanovic R, Verdeja JC (2013) Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms. Surg Endosc 27(12):4524–4531Google Scholar
  44. 44.
    Buzad FA, Corne LM, Brown TC, Fagin RS, Hebert AE, Kaczmarek CA, Pack AN, Payne TN (2013) Single-site robotic cholecystectomy: efficiency and cost analysis. Int J Med Robot 9(3):365–370Google Scholar
  45. 45.
    Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, Grosso F, Quarati R (2012) Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc 26(6):1648–1655Google Scholar
  46. 46.
    Hagen ME, Balaphas A, Podetta M, Rohner P, Jung MK, Buchs NC, Buehler L, Mendoza JM, Morel P (2018) Robotic single-site versus multiport laparoscopic cholecystectomy: a case-matched analysis of short- and long-term costs. Surg Endosc 32(3):1550–1555Google Scholar
  47. 47.
    Law J, Rowe N, Archambault J, Nastis S, Sener A, Luke PP (2016) First Canadian experience with robotic single-incision pyeloplasty: comparison with multi-incision technique. Can Urol Assoc J 10(3–4):83–88Google Scholar
  48. 48.
    Kaouk J, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A (2014) A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 66(6):1033–1043Google Scholar
  49. 49.
    White MA, Autorino R, Spana G, Hillyer S, Stein RJ, Kaouk JH (2012) Robotic laparoendoscopic single site urological surgery: analysis of 50 consecutive cases. J Urol 187:1696–1701Google Scholar
  50. 50.
    White MA, Autorino R, Spana G, Laydner H, Hillyer SP, Khanna R, Yang B, Altunrende F, Isac W, Stein RJ, Haber GP, Kaouk JH (2011) Robotic laparoendoscopic single-site radical nephrectomy: surgical technique and comparative outcomes. Eur Urol 59(5):815–822Google Scholar
  51. 51.
    White MA, Haber GP, Autorino R, Khanna R, Forest S, Yang B, Altunrende F, Stein RJ, Kaouk JH (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58(4):544–550Google Scholar
  52. 52.
    Shin TY, Lim SK, Komninos C, Kim DW, Han WK, Hong SJ, Jung BH, Rha KH (2014) Laparoendoscopic single-site (LESS) robot-assisted partial nephrectomy (RAPN) reduces postoperative wound pain without a rise in complication rates. BJU Int 114(4):555–561Google Scholar
  53. 53.
    Tiu A, Kim KH, Shin TY, Han WK, Han SW, Rha KH (2013) Feasibility of robotic laparoendoscopic single-site partial nephrectomy for renal tumors > 4 cm. Eur Urol 63(5):941–946Google Scholar
  54. 54.
    Olweny EO, Park SK, Tan YK, Gurbuz C, Cadeddu JA, Best SL (2012) Perioperative comparison of robotic assisted laparoendoscopic single-site (LESS) pyeloplasty versus conventional LESS pyeloplasty. Eur Urol 61(2):410–414Google Scholar
  55. 55.
    Won Lee J, Arkoncel FR, Rha KH, Choi KH, Yu HS, Chae Y, Han WK (2011) Urologic robot-assisted laparoendoscopic single-site surgery using a homemade single-port device: a single-center experience of 68 cases. J Endourol 25(9):1481–1485Google Scholar
  56. 56.
    Buffi NM, Lughezzani G, Fossati N, Lazzeri M, Guazzoni G, Lista G, Larcher A, Abrate A, Fiori C, Cestari A, Porpiglia F (2015) Robot-assisted, single-site, dismembered pyeloplasty for ureteropelvic junction obstruction with the new da Vinci platform: a stage 2a study. Eur Urol 67(1):151–156Google Scholar
  57. 57.
    Corrado G, Mereu L, Bogliolo S, Cela V, Freschi L, Carlin R, Gardella B, Mancini E, Tateo S, Spinillo A, Vizza E (2016) Robotic single site staging in endometrial cancer: a multi-institution study. Eur J Surg Oncol. 42(10):1506–1511Google Scholar
  58. 58.
    Jayakumaran J, Wiercinski K, Bungton CA (2018) Caceres robotic laparoendoscopic single-site benign gynecologic surgery: a single-center experience. J Robot Surg 12(3):447–454Google Scholar
  59. 59.
    Gungor M, Kahraman K, Dursun P, Ozbasli E (2018) Canan genim single-port hysterectomy: robotic versus laparoscopic. J Robot Surg 12(1):87–92Google Scholar
  60. 60.
    Matanes E, Lauterbach R, Mustafa-Mikhail S, Amit A, Wiener Z, Lior MHA (2017) Lowenstein single port robotic assisted sacrocolpopexy: our experience with the first 25 cases. Female Pelvic Med Reconstr Surg 23(3):e14–e18Google Scholar
  61. 61.
    Gargiulo AR, Choussein S, Srouji SS, Cedo LE, Pedro F (2017) Escobar coaxial robot-assisted laparoendoscopic single-site myomectomy. J Robot Surg 11(1):27–35Google Scholar
  62. 62.
    Bogliolo S, Ferrero S, Cassani C, Musacchi V, Zanellini F, Dominoni M, Spinillo A, Gardella B (2016) Single site versus multiport robotic hysterectomy in benign gynaecological diseases: a retrospective evaluation of surgical outcomes and cost analysis. J Minim Invasive Gynecol 23(4):603–609Google Scholar
  63. 63.
    Paek J, Lee J-D, Kong TW, Chang S-J, Ryu H-S (2016) Robotic single-site versus laparo-endoscopic single-site surgery for adnexal tumours: a propensity score-matching analysis. Int J Med Robot 12(4):694–700Google Scholar
  64. 64.
    Paek J, Lee J-D, Kong TW, Chang S-J, Ryu H-S (2016) Robotic single-site versus laparoendoscopic single-site hysterectomy: a propensity score matching study. Surg Endosc 30(3):1043–1050Google Scholar
  65. 65.
    Bogliolo S, Mereu L, Cassani C, Gardella B, Zanellini F, Dominoni M, Babilonti L, Delpezzo C, Tateo S (2015) Arsenio spinillo robotic single-site hysterectomy: two institutions’ preliminary experience. Int J Med Robot 11(2):159–165Google Scholar
  66. 66.
    Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212(2):179.e1–179.e8Google Scholar
  67. 67.
    Fagotti A, Corrado G, Fanfani F, Mancini M, Paglia A, Vizzielli G, Sindico S, Scambia G, Vizza E (2013) Robotic single-site hysterectomy (RSS-H) vs. laparoendoscopic single-site hysterectomy (LESS-H) in early endometrial cancer: a double-institution case–control study. Gynecol Oncol 130(1):219–223Google Scholar
  68. 68.
    Choi EJ, Rho AM, Lee SR, Jeong K, Moon HS (2017) Robotic single-site myomectomy: clinical analysis of 61 consecutive cases. J Minim Invasive Gynecol 24(4):632–639Google Scholar
  69. 69.
    de Meritens AB, Kim J, Dinkelspiel H, Chapman-Davis E, Caputo T, Holcomb K (2017) Feasibility and learning curve of robotic laparo-endoscopic single site surgery in gynecology. J Minim Invasive Gynecol 24(2):323–328Google Scholar
  70. 70.
    Akdemir A, Yildirim N, Zeybek B, Karaman S (2015) Fatih sendag single incision trans-umbilical total hysterectomy: robotic or laparoscopic? Gynecol Obstet Invest 80(2):93–98Google Scholar
  71. 71.
    Sendag F, Akdemir A, Zeybek B, Ozdemir A, Gunusen I, Oztekin MK (2014) Single-site robotic total hysterectomy: standardization of technique and surgical outcomes. J Minim Invasive Gynecol 21(4):689–694Google Scholar
  72. 72.
    Vizza E, Corrado G, Mancini E, Baiocco E, Patrizi L, Fabrizi L, Colantonio L, Cimino M (2013) Stefano sindico and ester forastiere robotic single-site hysterectomy in low risk endometrial cancer: a pilot study. Ann Surg Oncol 20(8):2759–2764Google Scholar
  73. 73.
    Moukarzel LA, Sinno AK, Fader AN, Tanner EJ (2017) Comparing single-site and multiport robotic hysterectomy with sentinel lymph node mapping for endometrial cancer: surgical outcomes and cost analysis. J Minim Invasive Gynecol 24(6):977–983Google Scholar
  74. 74.
    Vizza E, Chiofalo B, Cutillo G, Mancini E, Baiocco E, Zampa A, Bufalo A, Corrado G (2018) Robotic single site radical hysterectomy plus pelvic lymphadenectomy in gynecological cancers. J Gynecol Oncol 29(1):e2Google Scholar
  75. 75.
    Autorino R, Kaouk JH, Stolzenburg JU, Gill IS, Mottrie A, Tewari A, Cadeddu JA (2013) Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol 63(2):266–280Google Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • S. Cianci
    • 1
    Email author
  • A. Rosati
    • 1
  • V. Rumolo
    • 1
  • S. Gueli Alletti
    • 1
  • V. Gallotta
    • 1
  • L. C. Turco
    • 1
  • G. Corrado
    • 1
  • G. Vizzielli
    • 1
  • A. Fagotti
    • 2
  • F. Fanfani
    • 2
  • G. Scambia
    • 2
  • S. Uccella
    • 3
  1. 1.Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del BambinoFondazione Policlinico Univeristario A. Gemelli, IRCCSRomeItaly
  2. 2.Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Obstetrics and Gynecology DepartmentNuovo Ospedale degli InfermiBiellaItaly

Personalised recommendations