**10. The utility of the single site robotic system for minor gynecologic surgery**

Minor gynecologic surgery generally encompasses surgery on the adnexa and excision of pelvic endometriosis. The single site robotic approach for minor gynecologic surgery offers advantages over both traditional multi-port laparoscopic and robotic surgery. Compared to traditional multi-port surgery, the single site approach is more cosmetic, decreases postoperative pain, and removes the risk of trocar related complications.

In addition, with traditional multi-port laparoscopic or robotic surgery, specimen removal from the abdomen can be challenging. Often one of the incisions needs to be enlarged in order to extract the tissue, resulting in the potential for

**Figure 15.** *Redundant skin.*

*Single Port Gynecologic Laparoscopic and Robotic-Assisted Surgery*

**Figure 16.**

**28**

*Redundant skin is trimmed.*

increased post-operative pain and other wound complications. By contrast, single site robotic surgery provides easy access through the umbilicus for specimen retrieval and morcellation if necessary.

Compared to laparoscopic surgery, both single site and multi-port, the 3D binocular vision and the intuitive ergonomics of the robotic single site platform offer significant advantages. The 3D vision improves dexterity and makes complex ergonomic tasks easier. In addition, the manipulation of tissue is more intuitive with the single site system. This results in more fluid surgical movements and less sword fighting. Finally, although only the single site needle driver is wristed, this compares favorably to laparoscopic instruments that are all uniformly non-wristed.

When contemplating whether to employ the single site robotic approach, consider several factors. First, how difficult is the expected operation. Depending on the surgeon's experience and familiarity with single site surgery, more complex operations may necessitate a multi-port approach. Second, how skilled is the individual surgeon in performing laparoscopic single site surgery. Single site surgery, whether robotic or laparoscopic, virtually always benefits the patient. If a particular surgeon is skilled in laparoscopic single site surgery, this may be a more appropriate technique to use. For an experienced single site surgeon, the laparoscopic approach can be more efficient and can be performed with a slightly smaller umbilical incision.

Ovarian cystectomy is arguably the operation uniquely suited to the robotic single site system. Stripping of an ovarian cyst and suturing the ovary are ergonomically difficult with the laparoscopic single site approach. Multi-port approaches, whether laparoscopic or robotic, may facilitate performing the cystectomy, but they increase the risk for postoperative complications. With the robotic single site approach, the cyst can be easily opened and decompressed. The cyst lining is easily stripped using a grasper and wristed needle driver. Specimen retrieval is easily accomplished through the umbilicus.

For the same reasons, excision of pelvic endometriosis is an operation often well suited to the robotic single site approach. To excise endometriotic implants or explore the pelvic sidewall, significant dexterity is often required. The surgical site is often in a tight space with minimal mobility to the tissue. This creates difficulties even for the experienced laparoscopic single site surgeon.

When first starting to perform robotic single site surgery, the option of adding an additional 8 mm accessory trocar can increase the comfort level of the surgeon. The additional trocar makes all wristed robotic instruments potentially available to assist in the surgery. Eventually, with experience, the extra trocar will become less necessary. Adding the additional trocar mitigates but does not cancel out the benefits of the single site approach. One extra trocar is still better for the patient than 2 or 3 additional ones.

**Author details**

John R. Wagner

**31**

Reconstructive Surgery, New York, USA

provided the original work is properly cited.

\*Address all correspondence to: jrwagnermd@yahoo.com

Board Certified in Obstetrics and Gynecology and Female Pelvic Medicine and

*Fundamentals of the Robotic Assisted Laparoscopic Single Port System and Utility in Minor…*

*DOI: http://dx.doi.org/10.5772/intechopen.96588*

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

#### **11. Conclusion**

The robotic single site system provides a unique surgical approach that can be easily adopted and utilized for gynecologic surgery. It expands the opportunities to perform single surgery beyond just the laparoscopic approach. The single site approach, whether laparoscopic or robotic, virtually always benefits the patient. For the individual surgeon, especially one not particularly comfortable with laparoscopic single site surgery, the robotic single site system can facilitate the transition to single incision surgery as the primary approach to many gynecologic operations. However, even the experienced single site laparoscopic surgeon will find instances where the robotic single site approach is more advantageous.

*Fundamentals of the Robotic Assisted Laparoscopic Single Port System and Utility in Minor… DOI: http://dx.doi.org/10.5772/intechopen.96588*
