First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform Matthew Kroh • Kevin El-Hayek • Steven Rosenblatt • Bipan Chand • Pedro Escobar • Jihad Kaouk • Sricharan Chalikonda Received: 11 January 2011 / Accepted: 30 April 2011 / Published online: 3 June 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Background Interest in single-incision laparoscopic techniques continues to grow. A learning curve certainly exists, and although the techniques have improved, tech- nical considerations including external clashes, poor visu- alization of critical structures, and surgeon fatigue remain. Applications of robotics to these newer techniques are evolving. The da Vinci Single-Site robotic surgery plat- form is a new semi-rigid robotic operative system designed to work with the Intuitive Surgical da Vinci Si operative system. The authors present the first human experience with this new device used to perform single-incision lap- aroscopic cholecystectomy. This study aimed to present the first human experience performing cholecystectomy with a novel robotic single-port platform. Methods After Cleveland Clinic Institutional Review Board approval, patients with symptomatic biliary disease fitting standard criteria for cholecystectomy were enrolled in the study. A total of 13 consecutive single-port, robotic cholecystectomy operations were performed. Patient demographics and operative results were evaluated. Results All 13 operations were completed successfully with the Single-Site platform. A critical view of safety as determined by the operative surgeon was obtained in all cases. One patient required placement of an additional extra-umbilical trocar for appropriate visualization sec- ondary to gallbladder necrosis, and this incision also was used for eventual drain placement. For two patients, an intraoperative choloangiogram was performed. The mean operative time was 107 ± 54 min, and the mean docking time was 15 ± 9 min. Discharge for 11 patients was within 24 h. No significant complications occurred. Conclusion Cholecystectomy using the da Vinci Single- Site system is feasible. Availability of this new semi-rigid, robotic surgery platform may increase access to the potential advantages of single-site surgery. Additional advantages of single-site surgery may be elucidated with further studies. Keywords Da Vinci Single-Site system Á Single-incision laparoscopic cholecystectomy Á Single-incision laparoscopy Á Single-site robotic surgery Single-incision laparoscopic surgery continues to receive significant attention in the general surgery literature. Through the use of a single-access site, assumptions of less invasiveness have been purported. This appears to be somewhat substantiated by early studies. Postoperative cosmetic outcomes seem to be improved with these tech- niques, and some preliminary data may support faster recovery [1–5]. This remains to be proved in more rigorous studies, but clearly, interest in the development of these technologies currently exists. New technologies have improved the success and reproducibility of these single-access approaches including the use of flexible laparoscopes, flexible instruments, and internal retractors. However, significant obstacles still exist, mainly due to physical impediments of instrumentation. M. Kroh (&) Á K. El-Hayek Á S. Rosenblatt Á B. Chand Á S. Chalikonda Cleveland Clinic, Digestive Disease Institute, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA e-mail: krohm@ccf.org P. Escobar Cleveland Clinic, Women’s Health Institute, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA J. Kaouk Cleveland Clinic, Glickman Urologic Institute, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA 123 Surg Endosc (2011) 25:3566–3573 DOI 10.1007/s00464-011-1759-1