The "highly Versatile Single Port System" for laparoscopic surgery: Introduction and first clinical application

In minimally invasive surgery, trauma to the patient can be reduced by diminishing the number of entry ports. In addition a single port access, attaining "high flexibility" in laparoscopic interventions is also of utmost importance. We developed the "Highly Versatile Single Port System" (HVSPS), a two-armed device with an additional semi-flexible telescope, to meet these requirements. Both manipulators and the telescope are inserted independently through a three-channel trocar which is guided by a four degree of freedom telemanipulator. Furthermore, a simulation of the complete system including the surgical environment is programmed for user training and design optimization. The first gallbladder could be successfully resected in an animal experiment using the HVSPS. The manipulators were introduced into the abdominal cavity through a single incision. After the ligation of the cystic duct and artery with coagulation current, the gallbladder was held with a grasper and dissected using a TT knife. The complete surgical intervention, without technical set-up, was accomplished within 110 minutes. For the first time, the feasibility of laparoscopic cholecystectomy using the HVSPS has been shown in this study. However, such elaborate systems bring up new challenges such as the definition of an adequate human-machine interface and new control approaches for retroflective manipulations which are possible with the kinematic structure of the HVSPS.