Robotic Single-Site Pyeloplasty Using Crossed Articulating Instruments and 5 mm Flared Cannulas

Abstract

Introduction:

Previously, we have reported the ability to perform robotic single-site pyeloplasty safely and effectively using crossed robotic 5 mm articulating instruments. A recent cohort study of laparoendoscopic single-site (LESS) patients showed that robotic LESS (R-LESS) patients' outcomes compared favorably with conventional LESS (C-LESS) patients. In this series, R-LESS patients developed postoperative complications at a rate of 9.1% versus 29.0% compared with C-LESS patients, although the difference was not significant (p 003D; 0.097). Furthermore, the efficacy of R-LESS pyeloplasty was demonstrated, with a clinical success rate (resolution of symptoms) in 100% of patients. ¹ However, we have found that this technique has led to damage to the robotic arms in several cases rendering these unusable for subsequent procedures.

Materials and Methods:

We present a new method in which 5 mm flared cannulas, as opposed to the standard 5 mm beveled robotic cannulas, are used to reduce robotic instrument damage. One drawback to this system is the lack of an air tight seal with the flared cannulas, which can be circumvented by using a novel airlock mechanism using trans-rectal ultrasound probe covers. These are placed around the robotic instrument and cannula and provide an airtight mechanism to prevent the loss of pneumoperitoneum.

Results:

Currently, the estimated cost for a cautery hook and arm is $5760 for 18 uses and the estimated cost for the Maryland grasper is $4600 for 20 uses. Damage occurring earlier in the life of these instruments therefore significantly increase the cost per use. We present evidence that the demonstrated system is efficacious and negates instrument damage such that in all cases performed (n = 5) the instruments were available for subsequent use. We further demonstrate that when using our novel air lock mechanism, we are able to perform the surgery without loss of pneumoperitoneum.

Conclusion:

Robotic single-site pyeloplasty remains a viable option using our current technique of crossed articulating instruments. We have demonstrated that using flared cannulas along with our novel air lock system can mitigate robotic instrument damage.

Previously presented in modified form at the 2013 World Congress of Endourology, New Orleans, Louisiana.

The authors have no competing financial interests.

Running Time: 7 mins 54 secs