Single-site systems in general surgery

Robotic laparoendoscopic single-site surgery (R-LESS) has the potential to overcome the limitations of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) [1, 2]. To this date, Intuitive Surgical dominated the single-site robotic general surgery market with the multiport standard da Vinci platform and the curved instruments of the da Vinci single-site surgical platform (DVSSP). These platforms offer significant enhancement in optics and ergonomics and easier articulation of the instruments [1, 2]. R-LESS has been applied in various single-site general surgery procedures, such as the cholecystectomy, colectomy, transanal minimally invasive surgery, adrenalectomy, hernia surgery and transoral and transaxillary thyroidectomy [3]. However R-LESS remained suboptimal with the current platform compared to conventional techniques, and the applicability of R-LESS remained limited for selected general surgery procedures at a relatively limited scale. Dexterity and accessibility of the instruments are an important limiting factor. Intuitive Surgical addressed these technical issues with the recent introduction of the da Vinci SP. Moreover, with the expiration of Intuitive Surgical patents, new promising platforms with dedicated flexible endoscopes and elbowed robotic instruments have entered the robotic single-site market. Ongoing development of these purpose-built robotic platforms will broaden the indications of single-site robotic surgery and natural orifice transluminal endoscopic surgery. 1. Kaouk JH, et al. Robotic single-port transumbilical surgery in humans: initial report. BJU Int. 2009;103(3):366-9. 2. Spana G, Rane A, Kaouk JH. Is robotics the future of laparoendoscopic single-site surgery (LESS)? BJU Int. 2011;108(6 Pt 2):1018-23. 3. Qadan M, Curet MJ, Wren SM. The evolving application of single-port robotic surgery in general surgery. J Hepatobiliary Pancreat Sci. 2014;21(1):26-33.