Surgical Endoscopy

, Volume 32, Issue 3, pp 1273–1279 | Cite as

Randomized controlled trial of EndoWrist-enabled robotic versus human laparoendoscopic single-site access surgery (LESS) in the porcine model

  • Anthony Yuen Bun Teoh
  • Shannon Melissa Chan
  • Hon Chi Yip
  • Vivien Wai Yin Wong
  • Philip Wai Yan Chiu
  • Enders Kwok Wai Ng



A robotic laparoendoscopic single-site access surgery (R-LESS) platform that incorporates the EndoWrist function of robotic instruments may provide better triangulation and retraction during LESS. The aim of the study is to assess if R-LESS is feasible with standard robotic instruments via a single incision and whether the approach could reduce the difficulty of the procedure and confer additional benefits over conventional LESS.


This was a prospective randomized controlled study investigating the workload performance, efficacy, and risks of performing R-LESS when compared with human LESS (H-LESS) in a survival porcine model for cholecystectomy and gastrojejunostomy. The primary outcome is the NASA task load index. Secondary outcomes included the difficulty of the procedures, procedural time, morbidities, and mortalities.


Twenty-four cholecystectomies and gastrojejunostomies using the R-LESS or H-LESS approach (12:12) were performed. None of the swine suffered from procedural adverse events and none of the procedures required conversion. In both the cholecystectomy and gastrojejunostomy groups, R-LESS was associated with significantly lower NASA task load index (P < 0.001) and reduced difficulties in various steps of the procedures. No differences in the overall procedure times of the two procedures were observed (P = 0.315).


The R-LESS approach significantly reduced the workload and difficulties of LESS cholecystectomies and gastrojejunostomies. A dedicated single-site platform that could reduce instrument clashing while retaining the EndoWrist function is eagerly awaited.


Laparoendoscopic single-site access surgery Single-port surgery Robotic surgical procedures Cholecystectomy Gastrojejunostomy 



This study was supported by The Research Grant Council, Hong Kong.

Author contributions

Anthony Yuen Bun Teoh: Concept and design, writing of the manuscript, data analysis and interpretation. Shannon Melissa Chan: Data analysis and interpretation. Hon Chi Yip: Critical revision of the article. Vivien Wai Yin Wong: Critical revision of the article. Philip Wai Yan Chiu: Critical revision of the article. Enders Kwok Wai Ng: Critical revision and final approval of the article.

Compliance with ethical standards


Anthony Yuen Bun Teoh, Shannon Melissa Chan, Hon Chi Yip, Vivien Wai Yin Wong, Philip Wai Yan Chiu, and Enders Kwok Wai Ng have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongShatinChina

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