Robotic glove port technique for the endowristed rigid instruments in robotic single-site transabdominal and transvaginal surgery

Although robotic single-site (RSS) surgery employing cross setup of semirigid instruments allows effective triangulation of instruments, it has some limitations in performing RSS transabdominal and transvaginal surgeries. We introduced the robotic glove port technique (RGPT) using parallel setup of endowristed rigid instruments in performing RSS transabdominal surgery and transvaginal surgery in July of 2017. Thirty-five patients underwent RSS surgery with RGPT. Twenty-one patients had RSS transabdominal reconstructive or fertility-preserving surgeries such as myomectomy (12 patients), adenomyomectomy (3 patients), and ovarian endometriosis cystectomy (6 patients). Fourteen patients underwent robotic transvaginal surgery for natural orifice transluminal endoscopic surgery (NOTES) hysterectomy. All procedures were successfully performed, and no postoperative complications were observed. In all patients, the median total operative time, console time, and docking time were 160 min (range 106–240), 120 min (range 65–180), and 10 min (range 4–25), respectively. There was no conversion to another type of surgery, such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. The findings showed that RSS surgery via the RGPT is safe and feasible, using the parallel setup of endowristed rigid instruments is easily performed on transvaginal routes and transabdominal routes. Therefore, this procedure may be an important complement to gynecologic surgeons’ armamentarium in the field of robotic reconstructive or fertility-preserving surgeries such as myomectomy, adenomyomectomy, ovarian cystectomy, and transvaginal surgery for NOTES hysterectomy. Nevertheless, further prospective controlled studies are needed to determine its full clinical application. Similar content being viewed by others

Haber GP, Crouzet S, Kamoi K, Berger A, Aron M, Goel R, Canes D, Desai M, Gill IS, Kaouk JH (2008) Robotic NOTES (natural orifice translumenal endoscopic surgery) in reconstructive urology: initial laboratory experience. Urology 71:996–1000 Box GN, Lee HJ, Santos RJ, Abraham JB, Louie MK, Gamboa AJ, Alipanah R, Deane LA, McDougall EM, Clayman RV (2008) Rapid communication: robot-assisted notes nephrectomy: initial report. J Endourol 22:503–506 Kaouk JH, Goel RK, Haber GP, Crouzet S, Stein RJ (2009) Robotic single-port transumbilical surgery in humans: initial report. BJU Int 103:366–369 Escobar PF, Fader AN, Paraiso MF, Kaouk JH, Falcone T (2009) Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. J Minim Invas Gynecol 16:589–591 Nam EJ, Kim SW, Lee M, Yim GW, Paek JH, Lee SH, Kim S, Kim JH, Kim JW, Kim YT (2011) Robotic single-port transumbilical total hysterectomy: a pilot study. J Gynecol Oncol 22(2):120–126 Hagen ME, Wagner OJ, Inan I, Morel P, Fasel J, Jacobsen G, Spivack A, Thompson K, Wong B, Fischer L, Talamini M, Horgan S (2010) Robotic single-incision transabdominal and transvaginal surgery: initial experience with intersecting robotic arms. Int J Med Robo 6(3):251–255 Morelli L, Guadagni S, Caprili G, Di Candio G, Boggi U, Mosca F (2013) Robotic right colectomy using the Da Vinci Single-Site(R) platform: case report. Int J Med Robot 9:258–261 Lee CL, Wu KY, Su H, Han CM, Huang CY, Yen CF (2015) Robot-assisted natural orifice transluminal endoscopic surgery for hysterectomy. Taiwan J Obstet Gynecol 54(6):761–765 Yang YS, Oh KY, Hur MH, Kim SY, Yim HS (2014) Laparoendoscopic single-site surgery using conventional laparoscopic instruments and glove port technique in gynecology: a single surgeon’s experience. J Minim Invas Gynecol 19:403–408 Yang YS, Kim SH, Jin CH, Oh KY, Hur MH, Kim SY, Yim HS (2014) Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases. J Minim Invas Gynecol 21:695–701 Yang Y, Jin C, Oh K, Park J (2015) Hybrid laparoscopic myomectomy: a novel technique. Obstet Gynecol Sci 58:401–404 Yang YS, Kim SY, Hur MH, Oh KY (2014) Natural orifice transluminal endoscopic surgery-assisted versus single-port laparoscopic-assisted vaginal hysterectomy: a case-matched study. J Minim Invas Gynecol 21:624–631 Yang YS, Hur MH, Oh KY, Kim SY (2013) Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses. J Obstet Gynaecol Res 39:1604–1609 Kim SH, Jin CH, Hwang IT, Park JS, Shin JH, Kim DW, Seo YS, Sohn JN, Yang YS (2018) Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study. Obstet Gynecol Sci 61:261–266 Autorino R, Kaouk JH, Stolzenburg JU, Gill IS, Mottrie A, Tewari A, Cadeddu JA (2013) Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol 63(2):266–280 Matanes E, Lauterbach R, Boulus S, Amit A, Lowenstein L (2018) Robotic laparoendoscopic single-site surgery in gynecology: a systematic review. Eur J Obstet Gynecol Reprod Biol 231:1–7 Choi EJ, Rho AM, Lee SR, Jeong K, Moon HS (2017) Robotic single-site myomectomy: clinical analysis of 61 consecutive cases. J Minim Invas Gynecol 24(4):632–639 Moon HS, Shim JE, Lee SR, Jeong K (2018) The comparison of robotic single-site surgery to single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis. J Laparoendosc Adv Surg Tech A 28(12):1483–1488 Lewis EI, Srouji SS, Gargiulo AR (2015) Robotic single-site myomectomy: initial report and technique. Fertil Steril 103:1370–1377 Gargiulo AR, Choussein S, Srouji SS, Cedo LE, Escobar PF (2017) Coaxial robot-assisted laparoendoscopic single-site myomectomy. J Robot Surg 11(1):27–35 White MA, Haber GP, Autorino R, Khanna R, Forest S, Yang B, Altunrende F, Stein RJ, Kaouk JH (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58:544–550 Gargiulo AR, Bailey AP, Srouji SS (2013) Robot-assisted single-incision laparoscopic myomectomy: initial report and technique. J Robot Surg 7(2):137–142 Joseph RA, Goh AC, Cuevas SP, Donovan MA, Kaufman MG, Miles B, Reardon PR, Bass BL, Dunkin BJ (2010) “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc 24:1331–1335 Tobis S, Houman J, Thomer M, Rashid H, Wu G (2013) Robot-assisted transumbilical laparoendoscopic single-site pyeloplasty: technique and perioperative outcomes from a single institution. J Laparoendosc Adv Surg Tech A 23(8):702–706 Chung YJ, Kang SY, Choi MR, Cho HH, Kim JH, Kim MR (2016) Robot-assisted laparoscopic adenomyomectomy for patients who want to preserve fertility. Yonsei Med J 57:1531–1534 Chong GO, Lee YH, Hong DG, Cho YL, Lee YS (2016) Long-term efficacy of laparoscopic or robotic adenomyomectomy with or without medical treatment for severely symptomatic adenomyosis. Gynecol Obstet Invest 81:346–352 Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212:179.e1–179.e8 Moukarzel LA, Fader AN, Tanner EJ (2017) Feasibility of robotic-assisted laparoendoscopic single-site surgery in the gynecologic oncology setting. J Minim Invas Gynecol 24:258–263

The authors have no commercial, proprietary, or financial interest in the products or companies described in this article. Author information Authors and Affiliations Corresponding author Ethics declarations Funding No additional funding was received for this study. Ethical approval The study protocol was reviewed and approved by the institutional review board at Eulji University Hospital in 2018 (reference number 2018-11-025). Conflict of interest Dr. Yang has no conflicts of interest or financial ties to disclose. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Yang, Y.S. Robotic glove port technique for the endowristed rigid instruments in robotic single-site transabdominal and transvaginal surgery. J Robotic Surg 15, 241–249 (2021). https://doi.org/10.1007/s11701-020-01093-4 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11701-020-01093-4