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. 2019 Jan;11(1):231-239.
doi: 10.21037/jtd.2018.12.94.

Subxiphoid or subcostal uniportal robotic-assisted surgery: early experimental experience

Diego Gonzalez-Rivas  1   2   3 , Mahmoud Ismail  3
Affiliations

Subxiphoid or subcostal uniportal robotic-assisted surgery: early experimental experience

Diego Gonzalez-Rivas et al. J Thorac Dis. 2019 Jan.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors of this chapter have received compensation from Intuitive Surgical for consulting and/or educational services. The experimental labs discussed were supported by Intuitive Surgical.

Figures

Figure 1
Figure 1
Close up view of da Vinci SP system by Intuitive. There are 3 multi-joint Endowrist® instruments and an articulating camera. Various instruments may be exchanged and placed into different configurations. The camera may be oriented from above as shown or from below. The da Vinci SP is 510(k) cleared in the United States for urological procedures only at the time of this writing. (Image ©2018 Intuitive Surgical).
Figure 2
Figure 2
Overview of da Vinci SP system by intuitive. The da Vinci SP is 510(k) cleared in the United States for urological procedures only at the time of this writing. (Image ©2018 Intuitive Surgical).
Figure 3
Figure 3
Components of SP system. (A) 2.5 cm trocar with 4 working parallel channels (3 arms and camera); (B) robotic platform with a single arm; (C) SP robotic arm for training; (D) instruments and camera before being inserted in the system. SP, single port.
Figure 4
Figure 4
Position for subxiphoid and subcostal approach. (A) Lateral decubitus position, subxiphoid incision with Gel point system adapted and 2.5 cm trocar showing the 4 working channels; (B) right subcostal incision and direction of gel point system to be adapted to the wound protector (the additional thoracic incision is made to control from inside movements of the robot during experimental surgery); (C) stapler insertion by the surgeon for during a left upper lobectomy.
Figure 5
Figure 5
Lymph node dissection. (A) Paratracheal lymph node dissection; (B) right subcarinal lymph node dissection.
Figure 6
Figure 6
Left upper lobectomy. (A) Dissection of LUL vein; (B) division of LUL by using staplers; (C) use of vascular clips for apical artery; (D) dissection of LUL bronchus. LUL, left upper lobectomy.
Figure 7
Figure 7
Left lower lobectomy. (A) Dissection of LLL vein; (B) dissection on the fissure of artery. LLL, left lower lobectomy.
Figure 8
Figure 8
Right upper lobectomy. (A) Dissection of apico-anterior trunk of artery; (B) dissection of peribronchial tissue; (C) division of RUL vein; (D) completion of fissure (fissureless technique). RUL, right upper lobectomy.
Figure 9
Figure 9
Set up of console and robot during a subxiphoid robotic uniportal thymectomy (supine position of cadaver).
Figure 10
Figure 10
Thymectomy. (A) Dissection of left thymic lobe; (B) exposure of trachea and supraaortic trunks after complete thymectomy.
See this image and copyright information in PMC

References

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    1. Gonzalez-Rivas D, Paradela M, Fernandez R, et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 2013;95:426-32. 10.1016/j.athoracsur.2012.10.070 - DOI - PubMed
    1. Gonzalez-Rivas D, Sihoe AD. Important Technical Details During Uniportal Video-Assisted Thoracoscopic Major Resections. Thorac Surg Clin 2017;27:357-72. 10.1016/j.thorsurg.2017.06.004 - DOI - PubMed
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