Chopstick Surgery: A Novel Technique Enables Use of the Da Vinci Robot to Perform Single Incision Laparoscopic Surgery (SILS)

INTRODUCTION: Single incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with “wristed” instruments could overcome this limitation but the “arms” often collide when working coaxially. This study tests a new technique of “chopstick surgery” to enable use of the robotic arms through a single incision without collision.
METHODS: Experiments were conducted utilizing the da Vinci S ® robot (Sunnyvale, CA) in a box trainer with 3 laparoscopic ports (12mm, 2-5mm) introduced through a single “incision”. Pilot work varied the arrangement of the ports, distance between ports, and depth of the remote center while performing Fundamentals of Laparoscopic Surgery tasks (FLS, SAGES/ACS). This work determined the optimal set-up for SILS to be a triangular port arrangement with 2cm trocar distance and remote center at the abdominal wall. Using this set-up, four experienced robotic surgeons performed three FLS tasks utilizing either a standard robotic arm set-up or the “chopstick” technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This arrangement prevents collision of the robotic arms external to the box. To correct for the change in handedness, the robotic console is instructed to drive the “left” instrument with the right hand effector and the “right” instrument with the left. Performances were compared while measuring time, errors, number of clutching maneuvers, and degree of instrument collision (Likert Scale 1-4). Each drill was performed 3 times. If a task could not be completed within 10 min., it was terminated and the maximum time recorded (Results in minutes, mean±SEM).
RESULTS: Compared to the standard, the chopstick configuration enabled significantly improved times in all tasks (PEG transfer 1.6±0.2 vs. 5.5±1.1, p


Session: Podium Presentation

Program Number: S031

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