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single-port surgery.
Dr. White says the single-incision approach offers patients virtually scarless sur-
gery, and in her hands adds an increased degree of safety, thanks in part to inte-
grated fluorescence imaging that helps confirm aberrant duct anatomy during
cholecystectomies.
She says the robot's small, articulating instruments maneuver more finely than
the laparoscope's sharp movements during manual surgery, meaning patients
benefit from less traumatic interventions. The robot's 3D imaging lets her see
anatomy more clearly, including the critical view during cholecystectomy proce-
dures, and even brings nerves into better view during inguinal hernia repairs.
"We know to avoid the nerves during laparoscopic procedures, but you can't
always see them without the 3D imaging," she explains.
Docking the robot for single-port surgery requires additional training for sur-
geons who are expert in multi-port robotic procedures, says Dr. White. The sin-
gle-port robotic instruments are not wristed, so they don't articulate through 7
degrees of motion like conventional robotic tools do. Concerns persist about
single-incision surgery increasing incisional hernia risks — whether the proce-
dures are performed robotically or conventionally — but Dr. White has only
faced a couple during her 3-plus years of working with the robot. A larger single
incision means a higher risk of hernia, which may be the price to pay for cosme-
sis in some patients.
Dr. White says patients with higher BMIs are not ideal candidates for single-
incision robotic cholecystectomy, because the single port comes in only one
size. Intuitive Medical recommends limiting the single-incision approach to
patients with BMIs less than 50. "I've operated on patients with BMI in the 40s,
but prefer to focus on patients with BMIs of 35 and below," says Dr. White.
She performs 80% of her procedures with the robot, and says healthcare-savvy
patients in the Seattle area seek out the single-port approach for improved post-
op cosmesis.
