Floating docking technique: a simple modification to improve the working space of the instruments during single-port robotic surgery

Abstract

Objective

To compare the range of motion and ergonomic characteristics of single-port robotic instruments in the setting of the “floating” versus “flat” docking technique using the GelPOINT® system.

Material and methods

The basic principle of the floating docking technique resides in the GelSeal cap and trocar (s) being 8 cm off the skin level with the Alexis® acting as a conduit between the trocar (s) and the body while preserving insufflation.

In the setting of a dry lab study, we measured the range of motion of one robotic instrument with the “floating” and the “flat” docking technique in two different situations depending on whether the distance between the incision and the target was more or less than 10 cm.

Results

The minimum required distances between the target and the tip of the cannula for activation of the wrist and elbow were 5 and 10 cm, respectively. When the target was near to the cannula (i.e., less than 10 cm), the floating technique was associated with a significant increase in the range of motion of the instrument in all directions. The working space volume of the instrument was increased by more than 390% (from 101 to 497 cm3) when the surgeon switched from flat (standard) to the floating technique in the setting of a target close (i.e., less than 10 cm) to the cannula

Conclusion

The floating docking technique is a simple and effective way to increase the working surgical space, especially in confined and narrow surgical fields with a target closer than 10 cm from the skin.

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Affiliations

Authors

Contributions

LL: protocol/project development, data analysis, manuscript writing/editing. CAW: protocol/project development, manuscript writing/editing. GS: data collection or management. AA: manuscript writing/editing. SK: data collection or management. JK: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Jihad Kaouk.

Ethics declarations

Conflict of interest

Dr. Jihad Kaouk is a speaker with Intuitive Surgical. Louis Lenfant, Soodong Kim, Alireza Aminsharifi, Guilherme Sawczyn have no conflicts of interest or financial ties to disclose.

Research involving human participants, their data or biological material

Yes. This study was approved by our institution IRB and we certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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(Data transparency): Yes.

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Yes.

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(Software application or custom code): Not applicable.

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Lenfant, L., Kim, S., Aminsharifi, A. et al. Floating docking technique: a simple modification to improve the working space of the instruments during single-port robotic surgery. World J Urol (2020). https://doi.org/10.1007/s00345-020-03307-8

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Keywords

  • Single port surgery
  • Robotic surgery
  • Docking
  • Floating technique
  • Gelport