Robotic laparoendoscopic single-site surgery: From present to future

The continued effort of improving cosmesis and reducing morbidity in urologic surgery has given rise to novel alternatives to traditional minimally invasive techniques: Laparoendoscopic Single-site Surgery (LESS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES). Despite the development of specialized access devices and instruments, the performance of complex procedures using LESS has been challenging due to loss of triangulation and instrument clashing. A robotic interface may represent the key factor in overcoming the critical restrictions related to NOTES and LESS. Although encouraging, current clinical evidence related to R-LESS remains limited as the current da Vinci(®) robotic platform has not been specifically designed for LESS. Robotic innovations are imminent and are likely to govern major changes to the current landscape of scarless surgery.