Gasless Single-Port RoboSurgeon Partial Cystectomy: A Hybrid Technique Combining an Intravesical and Extravesical Approach

Abstract

Gasless single-port RoboSurgeon partial cystectomy using a novel hybrid technique is performed with the assistance of a system (RoboSurgeon) that involves the robotization of the surgeon. This hybrid technique combines an intravesical approach through a natural orifice, the external urethral orifice, and an extravesical approach through a coin-sized single port. The RoboSurgeon system consists of three components: a three-dimensional head-mounted display (3D-HMD), handheld robot-like devices, and an endoscope manipulation robot. Depending on the situation, part or all of this system is used. The 3D-HMD, which provides six fields of vision in front of the eyes regardless of head position, is always used by surgeons. Using the direct view obtained by moving the angle of sight downward, surgeons can receive instruments from the scrub nurse and can also observe the operative field to ensure safety. In partial cystectomy, by making use of the multivision function, each participant can simultaneously see both intravesical and extravesical views. This surgery achieves four key “no’s”: no high costs, no CO₂, no multiple ports, and no intraperitoneal injury. The adjustable port size provides safety and ease of learning. The aforementioned direct vision and adjustable port size facilitate the transition from open surgery. Without the RoboSurgeon system, single-port-like surgery, in which the port size is somewhat larger, can be performed using the procedures described herein.