Robotic Assisted Hepatectomy and Cholecystectomy in Single Incision Laparoscopic Surgery (SILS) Using Gelport

Maki Sugimoto, MD, Yosinori Morita, MD, Yuichiro Matsuoka, PhD, Mariko Man-i, MD, Shoko Fujiwara, MD, Tsuyoshi Sanuki, MD, Masaru Yoshida, MD, Takashi Toyonaga, MD, Takanobu Hayakumo, MD, Hiromu Kutsumi, MD, Etsuko Kumamoto, PhD, Kagayaki Kuroda, P. Kobe University

Single incision laparoscopic surgery (SILS) allows for the performance of major surgical procedures with a single small incision and minimal scarring. The daVinci Surgical System provides advantages of easy articulation and improved ergonomics; however, an ideal platform for these procedures has not been identified.
This pilot study was conducted to evaluate the GelPort laparoscopic system as an access platform for robotic SILS procedures by one surgeon, using a pig model.
All pigs had a general anaesthetic and were placed in the flank position. A 2-cm umbilical incision was made, through which a single port was placed and pneumoperitoneum obtained. Five male pigs underwent robotic SILS cholecystectomy and hepatectomy. The GelPort has been used as an access platform through a 2.5 cm umbilical incision.
All robotic SILS procedures attempted with the GelPort were completed successfully without complication and there was no need for additional ports to be placed. The mean (range) operative duration for cholecystectomy was 110 (90-130) min, respectively. The mean (range) estimated blood loss for all procedures was 20 (0-40) mL. The preparation time decreased with increasing number of cases.
Use of the GelPort as an access platform for robotic SILS procedures provides adequate spacing and flexibility of port placement and acceptable access to the surgical field for the assistant, especially during procedures that require a specimen extraction incision. Additional platform and instrumentation development will likely simplify robotic SILS procedures further as experience grows.
Robotic assisted single-site hepatectomy and cholecystectomy are feasible and effective using the GelPort robotic system, but with considerable limitations. Robotic systems designed specifically for single-site approach have the potential of alleviating several of the limitations, which exist with traditional laparoendoscopic single-site surgery.

Session: Poster
Program Number: P390
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