commentary

Robotic-assisted, single-site surgery: Having your surgical cake and

eating it too!

Kenneth T. Pace, MD, FRCSC

Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada

Cite as: Can Urol Assoc J 2016;10(3-4):89. http://dx.doi.org/10.5489/cuaj.3747

smaller incision size, but has a ﬁxed number of ports, more

issues with carbon dioxide leakage, and does not accom-

modate thick (or very thin) abdominal walls.

See related article on page 83.

One limitation of the technology available at the time

the authors performed their study was the lack of 5 mm

wristed instruments (especially of 5 mm wristed needle driv-

ers). They were able to circumvent this by using a standard

8 mm wristed needle driver either through the GelPort or

through the assistant port of the robotic SS port. Today,

however, wristed 5 mm needle drivers are available and will

further facilitate single-site surgery, particular the suturing

component.

rologists have struggled to introduce single-port sur-

gery into clinical practice for a variety of reasons:

cost, questions about the degree of beneﬁt when

compared with “traditional” multi-port laparoscopy, and

surgical challenges in using the technique. With ports so

close together, triangulation is lost, there is often clashing

of instruments, and reconstructive aspects of the procedure

(

particularly intracorporeal suturing) become more difﬁcult.

Is single-site surgery the killer app for the robotic plat-

form? It may be that the robot is the killer app for the

single-site surgery; the robot can greatly facilitate laparo-

endoendoscopic single-site surgery procedures by shorten-

ing the learning curve and minimizing the downsides of the

technique. However, cost and lack of availability across the

country continue to be barriers in the Canadian healthcare

system now, and for the foreseeable, short-term future.

The idea of taking fairly routine procedures (laparoscopic

simple or radical nephrectomy or laparoscopic pyeloplas-

ties) and making them ever more technically challenging is

a daunting one!

Robotic-assisted, single-site surgery has dangled the pros-

pect of being able to have your surgical cake and eating it

too: perform single-site surgery with all the beneﬁts to the

patients, without needing to worry about crossed instruments

(

since the Si model can eliminate that problem entirely),

Competing interests: Dr. Pace is an Advisory Board member for Amgen, Boston Scientiﬁc Corporation,

Ferring Canada, Janssen, and Paladin Labs; is on the Speaker Bureaus for Ferring Canada and Paladin

Labs; and has received support for a fellowship program from Cook Urological, Inc.

and also without needing to ﬁght with your surgical assist-

ant/camera-holder for precious space at the bedside. The

superior ergonomics of the robotic-assisted approach for

the surgeon are also obvious.

Law et al nicely demonstrate (albeit with a small sam-

Reference

ple size), that two approaches to robotic-assisted, single-

site pyeloplasty are feasible and workable, although each

approach has its own advantages and disadvantages. The

GelPort is more ﬂexible (in terms of number and size of ports

or instruments that can be used), accommodates different

body wall thicknesses better, but requires a larger incision

size. The Intuitive single-site access port system requires a

Law J, Rowe N, Archambault J, et al. First Canadian experience with robotic single-incision pyeloplasty:

Comparison with multi-incision technique. Can Urol Assoc J 2016;10(3-4):83-8. http://dx.doi.

org/10.5489/cuaj.3440

Correspondence: Dr. Kenneth Pace, Division of Urology, Department of Surgery, University of

Toronto, Toronto, ON, Canada; kenneth.pace@utoronto.ca

CUAJ • March-April 2016 • Volume 10, Issues 3-4

2016 Canadian Urological Association