Adding da Vinci single-port robotic-assisted surgery expands a mature practice alongside multiport robotics in complex urologic surgery.
The surgeon featured in our study is Dr. Richard E. Link, an experienced minimally invasive surgeon who embraced single site robotics to transform his mature minimally invasive urologic practice.
The hospitals were Baylor St. Luke’s Medical Center with 850 beds and Houston Methodist Hospital with more than 900 beds. Located in Houston, Texas, they are part of the integrated delivery network, CHI St. Luke’s Health System and Houston Methodist.
After pursuing access to an Intuitive da Vinci SP surgical system for several years, Link began using the system when it became available at the Houston Methodist Hospital in July of 2022. At the beginning, he was somewhat skeptical how single-port robotics would fit into a practice that already utilized multiport robotics and single site laparoscopy. Like many other urologic surgeons, he thought the da Vinci SP might help in a certain subset of clinical situations. As it turns out, single-port robotics rapidly transformed his diverse practice of kidney, ureter, and prostate surgery within only a few months.
Da Vinci SP’s unique features offer great versatility but also require thoughtful application alongside multiport robotics for complex urologic surgery.
Intuitive designed the da Vinci SP to complement rather than replace its multiport da Vinci X and Xi systems. Both platforms represent a "system" that can handle a variety of approved urologic procedures suitable for a minimally invasive approach. Single-port robotics is ideally suited to procedures within small working spaces outside the peritoneal cavity and presents a range of possibilities so far not easily accomplished with multiport robotics (such as transvesical surgery.) Link, who uses both multiport and single-port systems, applies each robot to each individual clinical situation to maximize operating room efficiency and patient outcomes.
Case volume and alternative access expedited learning curve and accelerated improvements in patient morbidity.
Early in his learning curve, Link focused on replicating transperitoneal surgery that he had been performing for many years using da Vinci multiport robotics and laparoscopy. In January 2023, when his primary practice site at Baylor St. Luke’s Medical Center acquired a da Vinci SP system, he had a revelation. With available access to the da Vinci SP, Link rapidly pushed through the learning curve and achieved greater insight into its value and applicability to his patients. The key to unlocking the system’s full potential came when Link left traditional transperitoneal procedures behind and expanded into retroperitoneal and transvesical surgery.
Da Vinci single-port procedures yielded impressive improvements in postoperative pain and hospital length of stay.1-4
After 20 years of performing multiport robotic surgery, just a few months of extensive single-port use convinced Link of the da Vinci SP’s unique versatility. Pure retroperitoneal partial nephrectomy procedures resulted in faster operative times, less postoperative pain, and much shorter hospital stays for his patients. The da Vinci SP also allowed him to address tumors almost anywhere in the kidney without entering the abdomen and without awkward patient positioning. Likewise, shifting his busy simple prostatectomy practice out of the abdomen and into transvesical simple prostatectomy resulted in same-day discharge, no bladder irrigation or drains, and minimal discomfort for most of his patients.5-6 It was hard to ignore the impressive benefits that patients experienced from the alternative access advantages made possible by da Vinci SP’s single-port robotic surgery.
Link has created an evolving multisystem practice centered around truly customized surgery with the “right platform for the right patient.” This experience was transformative and left him with shareable and practical strategies to ease single-port robotic surgery adoption for other surgeons.
Find out more about da Vinci SP and the transformation of Dr. Link’s urology practice. See how incorporating single-port surgery into his established robotics practice added versatility and new approaches for complex urology procedures.
Financial disclosure
Dr. Link has received compensation from Intuitive for consulting and/or educational services.
Important safety information
For important safety information, including surgical risks and considerations, please also refer to www.intuitive.com/safety. For a product’s intended use and/or indications for use, risks, full cautions and warnings, please refer to the associated user manual(s).
Surgeon disclosure
The material presented represents the views, experiences, and opinions of independent surgeons based on their practice and personal experience performing surgery with the da Vinci surgical systems. Their experience may or may not be reproducible and is not generalizable.
Da Vinci Xi/X system precaution statement
The demonstration of safety and effectiveness for the representative-specific procedures did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease/condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.
Da Vinci SP system (TORS and URO)
The safety and effectiveness of this device for use in the performance of general laparoscopic surgery procedures have not been established. This device is only intended to be used for single-port urological procedures and for transoral otolaryngology surgical procedures in the oropharynx for benign tumors and malignant tumors classified as T1 and T2 with the da Vinci EndoWrist SP Instruments and the da Vinci SP surgical system TSP1098X.
The demonstration of safety and effectiveness was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to treatment of cancer (overall survival, disease-free survival, local recurrence).