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Introduction: SSL introduces ergonomic challenges while establishing the critical view during dissection of the Triangle of Calot (TOC). This study investigates the use of a novel percutaneous instrument platform and MAGS in performing SSL cholecystectomy with a technique that closely mimics four-port cholecystectomy.Methods: SSL cholecystectomy was performed on four female cadavers via a 15-18-mm incision made at the umbilicus for introduction of these devices and the working port. MAGS comprises an internal effector with a retractable monopolar cautery hook coupled across the abdominal wall to an external magnet held by the surgeon. The novel grasper was introduced percutaneously in the RUQ and comprises a 3-mm transabdominal shaft mated to a 5-mm end effector intracorporeally. Retraction was accomplished using the percutaneous grasper to manipulate the fundus and a standard 5-mm grasper at the umbilicus for the infundibulum. Dissection was performed by using a combination of the MAGS and a standard Maryland dissector. Total procedure time, time from procedure start to obtain a critical view of the TOC and clipping and dividing the cystic duct/artery, time for dissection of the gallbladder from the liver bed, and thickness of the abdominal wall at the umbilicus were measured.Results: The critical view was obtained in each case, and all four procedures were completed successfully. Mean procedure time was 40 (range, 33-51) min; time from procedure start to obtaining the critical view and clipping and dividing the cystic duct/artery was 33 (range, 28-38) min, and time for dissection of the gallbladder from the liver bed was 6.7 (range, 3-13) min. The mean abdominal wall thickness was 1.9 (range, 1.5-2) cm.Conclusions: The use of a novel graspers and MAGS overcomes the limitations of SSL cholecystectomy and improves surgeon dexterity. Making SSL feel more like traditional laparoscopy will enable a wider adoption of this procedure in the community. [ABSTRACT FROM AUTHOR]

Introduction: Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with wristed instruments could overcome this limitation, but the arms often collide when working coaxially. This study tests a new technique of "chopstick" surgery to enable use of the robotic arms through a single incision without collision.Methods: Experiments were conducted utilizing the da Vinci S robot (Intuitive Surgical, Inc., Sunnyvale, CA) in a Fundamentals of Laparoscopic Surgery (FLS) box trainer with three laparoscopic ports (1 x 12 mm, 2 x 5 mm) introduced through a single "incision." Pilot work determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, five experienced robotic surgeons performed three FLS tasks utilizing either a standard robotic arm setup or the chopstick technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This results in separation of the robotic arms outside the box. To correct for the change in handedness, the robotic console is instructed to drive the "left" instrument with the right-hand effector and the "right" instrument with the left. Performances were compared while measuring time, errors, number of clutching maneuvers, and degree of instrument collision (Likert scale 1-4).Results: Compared with the standard setup, the chopstick configuration increased surgeon dexterity and global performance through significantly improved performance times, eliminating instrument collision, and decreasing number of camera manipulations, clutching maneuvers, and errors during all tasks.Conclusion: Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery. [ABSTRACT FROM AUTHOR]