Single-Port Robotic Surgery in Urology: The New Beginning After the Advent of Dedicated Platforms

Single-Port Robotic Surgery in Urology: The New Beginning After the Advent of Dedicated Platforms describes the novel field of robotic single-port urologic surgery. Recent advances in surgical robotics combined with the pursuit to reduce the invasiveness of laparoscopic surgery have led to the development of novel robotic platforms specifically designed for single-port surgery. This reference summarizes the state-of-the-art of robotic single-port urologic surgery. Coverage takes a three-part approach, providing a description of the technological evolution which led to the advent of novel platforms specifically designed for single-port surgery, describing the urological procedures that can be performed, and outcomes and potential drawbacks.

• Provides a description of the current status of single-port robotic urologic surgery performed using novel dedicated platforms
• Expands understanding on why single-port is better than the standard multi-arms robotic approach, highlighting an analysis of surgical steps
• Summarizes data about each intervention, including pooled comparative analyses, to provide the most evidence-based examination possible

• Language: English
• Publisher: Academic Press
• Release date: Jun 14, 2022
• ISBN: 9780323985154

Book preview

Preface

Urology is a technology-driven specialty and has traditionally integrated new minimally invasive approaches at its early stage.

In the last decade, while looking for the least invasive approach, an attempt to shift from the traditional multiincision laparoscopic surgery to the single-incision laparoscopic surgery (the so-called laparoendoscopic single-site surgery—LESS) was observed. However, several drawbacks were observed with the laparoscopic single-site approach, including limited surgical movements and external clashing of instruments. These made the laparoscopic approach challenging to be performed, with a long learning curve even for skilled laparoscopic surgeons, resulting in limited diffusion of pure LESS.

The introduction of dedicated purpose-built devices and instruments for robotic platforms renewed the interest for this approach, paving the way to robotic LESS. Robotic LESS was seeking an easing of the known drawbacks typical of the pure LESS approach.

The first series of robotic LESS in urology was described in 2008 by Jihad Kaouk at Cleveland Clinic.

At that time, Riccardo Bertolo was just a medical student in Turin, getting in contact with the wonders of robotic urology inspired by Prof. Francesco Porpiglia.

Since then, several studies on robotic LESS applied to many urological procedures followed. Despite some reported benefits, consistent drawbacks including the external clashing and the limited accessibility for the assistant surgeon remained, so that robotic LESS did not spread.

Riccardo’s mentor, Prof. Porpiglia, had the great idea to invent a unique meeting, aimed to show the most recent technological innovations introduced in the daily armory of urologic surgeons, and to determine if they could have ever replaced the current approaches in the treatment of urologic diseases.

It was in 2013 during the first edition of this Techno-Urology Meeting in Turin that Jihad and Riccardo met each other for the first time.

Jihad was the invited cochairman of the meeting and performed a robot-assisted LESS partial nephrectomy. Not surprisingly, Riccardo was fascinated by this new technology and technique, in hands so capable of making the most of it.

Collaborations started after that meeting, to the point that, in 2017, Riccardo moved as a urologist and PhD student in bioengineering to Cleveland Clinic to work with Jihad for a 1-year fellowship in robotic urology.

That was an unmissable chance for him to surf the promising wave of the new robotic platform coming to Cleveland Clinic, purpose-built to perform robotic LESS surgery, potentially representing a step forward in robotic urology.

Led by Jihad Kaouk’s vision and inspiration, preclinical and preliminary clinical experiences were performed in all the major urological surgical interventions by using this novel platform, with Riccardo and Jihad, together with another energetic fellow, Dr. Juan Garisto, publishing around 50 scientific papers together as a team, during that 1-year time span.

The investigated features of the novel robotic platform were democratizing robotic LESS, so that it is being nowadays performed by many surgeons across the United States and far East, thus coming out of the niche.

After more than 3 years, beyond their working collaboration, a friendship has formed between Riccardo and Jihad. With this novel platform being on the market, they felt to capitalize it and to invest their effort and personal experience to offer other robotic teams around the world an educational support in the field.

They believed a comprehensive book would have been welcome. Thus they have invited the top expert robotic single-port teams from the United States, who contributed to this work, trying to highlight the new standards of single-port robotic urology today, while showing its future directions.

We are delighted that this book has come to a fruitful conclusion after a year of hard work.

Our thanks go to Stacy Masucci and Timothy Bennett from the Elsevier team for their great editorial assistance.

We are grateful to our families for their support and tolerance of our high professional workload.

We thank everybody for their motivation as well as for their criticism in the past—all of you have brought forward the vision of minimizing the invasiveness of minimally invasive urology, while keeping the highest standards.

A dream is becoming reality…what was just a pioneer experience some years ago is now taking place as a true indication in the world of robotic urology!

Riccardo Bertolo and Jihad Kaouk together in Dr. Kaouk’s office at the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA, in 2018.

Riccardo Bertolo¹ and Jihad Kaouk², ¹Department of Urology, San Carlo di Nancy Hospital, Rome, Italy, ²Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States

Chapter 1

The evolution of robotic single-port dedicated platforms

Riccardo Autorino¹, Christopher Bednarz¹, Fairleigh Reeves² and Prokar Dasgupta³,    ¹Division of Urology, Department of Surgery, VCU Health, Richmond, VA, United States,    ²Guy’s and St Thomas’ Hospital, London, United Kingdom,    ³King’s Health Partners, London, United Kingdom

Abstract

Both natural orifice transluminal endoscopic surgery and laparoendoscopic single-site surgery (LESS) were developed to further reduce the morbidity and scarring associated with minimally invasive surgical intervention. These techniques shared a common underlying hypothesis, that a reduction in the number of transcutaneous points of access (i.e., trocar sites) may ultimately translate into better outcomes, less complications, and faster postoperative recovery. In 2007 Rane et al. presented at the 25th World Congress of Endourology in Cancun the first successful LESS case in urology. The initial enthusiasm was, however, tempered by the technical challenges related to the use of a single access point, forcing the surgeon to work with laparoscopic instruments in parallel and causing by default reduced range of instrument movements, limited extraabdominal working space, and unfavorable ergonomics. These limitations de facto restrained the implementation of LESS to few surgeons worldwide and in few selected cases. The recognized benefits of the robotic-assisted laparoscopy over conventional laparoscopy include superior ergonomics, optical magnification of the operative field, enhanced surgeon dexterity, and precision of surgical manipulation. It was, therefore, natural to try to use the da Vinci robotic system to facilitate LESS. In 2009 Kaouk and his team reported the first successful series of single-port robotic procedures in humans. With the adoption of robotic technology, a new era seemed to start, but it soon became clear that technical challenges still existed, given the lack of a purpose-built robotic system. In this chapter, we discuss the evolution of robotic single-site or single-port surgery in urology, including trends, techniques, challenges, outcomes, and technological advances made until the release of the first commercially available purpose-built robotic platform.