Abstract
We appreciate the kind words of the authors and we agree that magnetic technology will be a great facilitator of single incision procedures.
According to the concept the retraction provided by LMSS lies in the unique vector which may be impractical with da Vinci SP robot system. We believe it is exactly the contrary. One of the main features of the magnetic technology is the capability to provide retraction without the restriction of the entry port. In the case of the SP, you can create retraction in the opposite site of the entry point, helping in creating triangulation without compromising the movements of the SP robot.
The difference between the Levita System and a conventional 5 mm port, is the capability of the Levita System to generate different angles of traction and not to be constrained by the entry point. There is growing evidence that avoiding incisions may not be of great importance for the surgeons, but it is a very important factor for the patient in terms of final perception of the overall result of the surgery. 1,2
The Levita System is a new technology and evidence of the benefits in urology is under development. Nevertheless, in a recently published study conducted at Duke University in bariatric procedures, demonstrated that using the Levita System for liver retraction in obese patients leads to less pain and shorter length of stay. 3
In this initial experience the LMSS was not used to retract the liver but in subsequent cases, considering the use in bariatric cases; the system could be used with excellent results.
Our aim was to avoid using the fourth robotic arm. As this is the first experience from our group, we noted significant improvements when obtaining more experience using the system. For the first cases we decided not to save the fourth arm and have it inside the patient in case we may need it. As long as we felt more confident with the system, we started not placing the fourth robotic arm.
Regarding the last question: Yes, we continued using the system and new publications will follow in the future.