Background Despite cosmetic advantages of single incision surgery and NOTES, technical challenges using only one access make these techniques non-intuitive and widespread acceptance is limited. Robotic surgery might have the potential to overcome such hurdles due to the option of unusual arm configurations, computer technology to change robotic arm control and alternative setup options. We report our initial experience with robotic single incision surgery with intersecting robotic arms both through the abdominal wall and the vagina in human cadavers. Materials and methodsThe da Vinci Standard System (Intuitive, Sunnyvale, CA, USA) was used to perform single incision surgery in human cadavers transabdominally and the da Vinci S system was used transvaginally. For the transabdominal access, a robotic 10-mm scope stabilized with a 12 mm port and two 5-mm robotic instruments were introduced through a multichannel single port (TriPort, ACS, Wicklow, Ireland) through the abdominal wall. The camera was placed centrally and both robotic arms were crossed at the level of the abdominal wall, inverting both instruments` tips to achieve triangulation. Cables of the robotic arms (Da Vinci standard) were switched from right to left and vice versa at the surgical console to reverse the control of working arms and thereby to achieve intuitive manipulation. The same robotic setup was used for the transvaginal access with the da Vinci S System, but camera and working arms were introduced through separate trocars and the control of robotic arms was switched at the surgical console.ResultsWith the transabdominal setup, it was possible to work with the robotic system in the typical, intuitive fashion even though working arms were intersected. A slight loss of range of motion was discovered due to the unusual setup of the working arms. Still, tissue manipulation and suturing was easily possible. Set-up allowed the usual range within the operative field. Transvaginal setup including docking of the system and introduction of instruments into the abdominal cavity was possible, put no useful manipulation could be peformed due to space restriction of the vagina and between the thighs.Conclusions Transvaginal robotic surgery with the da Vinci Surgical System does not appear to be feasible using the above setup. Though, transabdominal robotic single port surgery is feasible by using intersected robotic working arms crossed at the level of the abdominal wall and reversed robotic arm control. This approach seems to offer all advantages of single incision surgery while maintaining the intuitive control of robotic surgery. Clinical application appears justified.