Use of the new Endowrist needle-drivers in Single Site Robotic Pyeloplasty: evaluation of the pro & contra during the first 2 cases performed in our centre

==inizio abstract==

A major drawback of Robotic Single Site Pyeloplasty is the presence of semi-rigid instruments with great limitations in the degrees of movement. To overcome this problem Intuitive Surgical (Sunnyvale CA) has recently developed a new Wristed Needle Driver for Single Site Surgery aimed to facilitate suturing.
We describe the first two cases of Robotic Single Site Pyeloplasty performed in Italy using the new EndoWrist Needle Driver for Single Site Surgery.
In February 2015 two Patients underwent Robotic Single Site Pyeloplasty performed using this device.
Mean operative time was 160 min (IQR 150-170), mean single port positioning time was 12.5 min (IQR 10-15) and mean docking time was 11.5 min (IQR 11-12). Estimated blood loss was not significant in both cases. Hospital stay was 2 days in both cases. No complications occurred during surgery and in the early post-operative days. Follow-up is 3 months with no late complications reported.
We noticed that this new device can be useful by facilitating suturing, as the surgeon can move the instrument tip up to 45 degrees in all directions, and by its possible use as a forcep for dissection and tissue manipulation thanks to its greater handiness with respect to standard instruments for single-site surgery. The only disadvantage noticed in these cases is the presence of a slight tremor in fine movements probabily due to the collision of the needle driver with the rigid curved cannulae.
Our impression is that the new Endowrist needle driver represents a very useful device in improving the surgeon’s ease of suturing and instruments’ movements thus reducing the drawbacks of Single Site Surgery and making this more reproducibile. This is the first step to make Single Site more similar to Multi Port Surgery and to its widespread use not only limited to Pyeloplasty.

==fine abstract==