Robotic Systems in Laparoendoscopic Single-Site Surgery

To overcome the current constraints of LESS, it has been postulated that robotic technology could be applied. In this chapter an overview of current and future robotic systems for application in urologic LESS is provided. While the current da Vinci® system has shown to be a valuable ally in LESS, this is not what it was specifically designed for. The introduction of the da Vinci Single-Site® instrumentation has represented a step forward on one side, as it addresses some of the current drawbacks, mainly the clashing and lack of triangulation. However, the lack of EndoWrist® technology at the instrument tips, which probably has represented the main feature of robotic surgery as compared with standard laparoscopy, remains a major limitation. The ideal robotic platform for LESS should have a low external profile, the possibility of being deployed through a single-access site, and the possibility of restoring intra-abdominal triangulation while maintaining the maximum degree of freedom for precise maneuvers and strength for reliable traction. A number of robotic prototypes are currently being developed and might be available in the near future for urologic LESS applications.