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Gasless two-port access RoboSurgeon retroperitoneoscopic nephroureterectomy, which is an affordable procedure for patients with upper tract urothelial carcinoma, combines two single-port surgeries in that the kidney and upper ureter are isolated via the ipsilateral flank port and the lower ureter with bladder cuff via the ipsilateral lower abdominal pararectal port. This surgery is performed with the assistance of the RoboSurgeon system, which consists of three components: a three-dimensional (3D) head-mounted display (3D-HMD), handheld robot-like devices, and an endoscope manipulation robot. Depending on the situation, part or all of this system is used, but the 3D-HMD, which provides six fields of vision in front of the eyes regardless of head position, is always used by surgeons. When cosmetic results are most important, transumbilical single-port access can be selected. This surgery achieves four key “no’s”: no high costs, no CO2, no multiple ports, and no intraperitoneal injury. The adjustable port size ensures safety and ease of learning. The direct view, obtained by moving the angle of sight downwards while wearing on the 3D-HMD, coupled with the adjustable port size, facilitates the transition from open surgery. Without the RoboSurgeon system, single-port-like surgery can be performed using the procedures described herein.

Gasless single-port RoboSurgeon retroperitoneoscopic adrenalectomy, which is an affordable procedure for patients with various types of adrenal tumors, is carried out through a coin-sized single port and is assisted by a system (RoboSurgeon) that involves the robotization of the surgeon. The RoboSurgeon system consists of three components: a three-dimensional head-mounted display (3D-HMD), handheld robot-like devices, and an endoscope manipulation robot. Depending on the situation, part or all of this system is used. The 3D-HMD, which provides six fields of vision in front of the eyes regardless of head position, is always used by surgeons. The direct view obtained by moving the angle of sight downward allows the surgeons to see a wide panoramic operative field, which ensures safety. This surgery achieves four key “no’s”: no high costs, no CO2, no multiple ports, and no intraperitoneal injury. For patients with large pheochromocytoma, however, a transperitoneal approach with similar surgical maneuvers is an alternative. The aforementioned direct vision and adjustable port size provide safety, ease of learning, and transition from open surgery without difficulty. Without the RoboSurgeon system, a single-port-like adrenalectomy in which the port size is somewhat larger can be performed using the procedures described herein.

Gasless single-port RoboSurgeon clampless sutureless partial nephrectomy is performed for a wide range of renal tumors. It is an affordable procedure for patients with renal cell carcinoma and is carried out in a wide retroperitoneal working space made along the anatomical plane through a coin-sized single port. This surgery can be accomplished without vascular clamping using “the mushroom technique” and is assisted by a system (RoboSurgeon) that involves the robotization of the surgeon. The RoboSurgeon system consists of three components: a three-dimensional head-mounted display (3D-HMD), handheld robot-like devices, and an endoscope manipulation robot. Depending on the situation, part or all of this system is used. The 3D-HMD, which provides six fields of vision in front of the eyes regardless of head position, is always used by surgeons. Using the direct view obtained by moving the angle of sight downward, surgeons can receive instruments from the scrub nurse and can also observe the operative field to ensure safety. This surgery achieves four key “nos”: no high costs, no CO2, no multiple ports, and no intraperitoneal injury. The adjustable port size provides safety and ease of learning. The aforementioned direct vision and adjustable port size facilitate the transition from open surgery. Without the RoboSurgeon system, single-port-like surgery, in which the port size is somewhat larger, can be performed using the procedures described herein.

The concept of the RoboSurgeon system can be applied to not only minimally invasive surgery but also to many types of medical procedures. The head-mounted display (HMD), which is a part of the RoboSurgeon system, is used as a personal integrated-image monitor. The HMD provides the wearer with six fields of vision, including magnified vision, stereovision, panoramic vision, multivision, navigated vision, and shared vision. Various types of imaging information can be input to the HMD by arranging the system components. Moreover, multiple streams of information can be seamlessly displayed on HMD by combining video splitters and multiplexers with the HMD. All the participants, including medical staff, and even students and patients can simultaneously share the information by each wearing an HMD. Furthermore, each HMD wearer can independently rearrange the images that make up the composite image displayed on his or her HMD depending on the step of the procedure. Importantly, the HMD system is compact and easily introduced due to its affordable cost. Therefore, we can apply this system even in transurethral procedures or outside the operating room. The RoboSurgeon system offers enormous potential for refining many types of medical procedures and practice.

Gasless single-port pelvic lymph node dissection and inguinal hernia prevention are carried out in the wide retroperitoneal pelvic working space made along the anatomical plane through an approximately coin-sized single port. These are affordable procedures often performed together with many gasless single-port RoboSurgeon surgeries for the pelvic organs including radical/partial cystectomy and radical prostatectomy, and they are assisted by a system (RoboSurgeon) that involves the robotization of the surgeon. The RoboSurgeon system consists of three components: a 3D head-mounted display (3D-HMD), handheld robot-like devices, and an endoscope manipulation robot. Part or all of this system is used depending on the situation, but the 3D-HMD, which provides six fields of vision in front of the eyes regardless of head position, is always used by surgeons. The direct view obtained by moving the angle of sight downward allows the surgeons to see a wide panoramic operative field to ensure safety. This surgery is safe and easy to learn, and transition from open surgery can be completed without difficulty. Without the RoboSurgeon system, single-port-like surgery, in which the port size is somewhat larger, can be performed using the procedures described herein.

Gasless single-port RoboSurgeon total cystectomy with urinary diversion is carried out in the wide pelvic retroperitoneal working space made along the anatomical plane through a single port, around 4–5 cm in diameter, assisted by the robotization of the surgeon using a system called RoboSurgeon. The RoboSurgeon system consists of three components: a three-dimensional head-mounted display (3D-HMD), handheld robot-like devices, and an endoscope manipulation robot. Part or all of this system is used depending on the situation, but the 3D-HMD, which provides six fields of vision in front of the eyes regardless of head position, is always used by surgeons. Using the direct vision obtained by moving the angle of sight downward, the surgeons receive instruments from the scrub nurse as well as observe the operative field to ensure safety. Along with total cystectomy, urinary diversion (either orthotopic neobladder or ileal conduit) is performed by extracting the ileum through the single port. Performing this surgery achieves three key “nos”: no high costs, no CO2, and no multiple ports, along with minimal intraperitoneal injury. Patients who had previously undergone extensive intraperitoneal surgery would benefit the most. Transition from open surgery can be accomplished without much difficulty. Without the RoboSurgeon system, single-port-like surgery, in which the port size is somewhat larger, can be performed using the procedures described herein.