The new robotic TELELAP ALF-X in gynecological surgery: single-center experience

Analyzing the emergence of surgical robotics in Africa: a scoping review of pioneering procedures, platforms utilized, and outcome meta-analysis

Purpose

Surgical practice globally has undergone significant advancements with the advent of robotic systems. In Africa, a similar trend is emerging with the introduction of robots into various surgical specialties in certain countries. The need to review the robotic procedures performed, platforms utilized, and analyze outcomes such as conversion, morbidity, and mortality associated with robotic surgery in Africa, necessitated this study. This is the first study examining the status and outcomes of robotic surgery in Africa.

Methods

A thorough scoping search was performed in PubMed, Google Scholar, Web of Science, and African Journals Online. Of the 1,266 studies identified, 16 studies across 3 countries met the inclusion criteria. A meta-analysis conducted using R statistical software estimated the pooled prevalences with the 95% confidence interval (CI) of conversion, morbidity, and mortality.

Results

Surgical robots are reportedly in use in South Africa, Egypt, and Tunisia. Across four specialties, 1,328 procedures were performed using da Vinci (Intuitive Surgical), Versius (CMR Surgical), and Senhance (Asensus Surgical) surgical robotic platforms. Urological procedures (90.1%) were the major procedures performed, with robotic prostatectomy (49.3%) being the most common procedure. The pooled rate of conversion and prevalence of morbidity from the meta-analysis was 0.21% (95% CI, 0%-0.54%) and 21.15% (95% CI, 7.45%-34.85%), respectively. There was no reported case of mortality.

Conclusion

The outcomes highlight successful implementation and the potential for wider adoption. Based on our findings, we advocate for multidisciplinary and multinational collaboration, investment in surgical training programs, and policy initiatives aimed at addressing barriers to the widespread adoption of robotic surgery in Africa.

Exploring robotic total hysterectomies: a multi-site experience with the Senhance Surgical System

Robotic-assisted surgery emerged as a technological advancement in the twentieth century, with gynaecology being a key adopter of this approach. The Senhance Surgical System has gained prominence for total hysterectomies from single-site experiences, but multi-site reporting are still lacking in present literature. This multi-site study, conducted at Klaipeda University Hospital and Academic Teaching Hospital Feldkirch, aimed to explore the safety and feasibility of total hysterectomies with the Senhance Surgical System. The study involved 295 cases, showcasing a well-established routine with minimal procedure times. The average age of the patients was 53.5 years (SD: 10.3 years), ranging from 18 to 80 years. The patients' BMI averaged 25.6 kg/m2 (SD: 6.2 kg/m2), ranging from a minimum of 17.7 kg/m2 to a maximum of 69.5 kg/m2. The duration of surgery varied between 30 and 215 min, with a median of 95 min (IQR: 81-116). The docking time was a median of 3 (IQR: 2-5) min and varied between 1.0 and 30.0 min, with a minimum to a maximum range of 1.0 to 122 min. Conversion (3 cases, 1%) and adverse events (6 cases, 2%) were infrequent. Additionally, robotic malfunctions were recorded minimally in 4,1% (12 cases) of the procedures, and pain on a 0-10 visual pain scale was reduced from mild [2.7 (± 1.2)] one day postoperative to minimal [0.9 (± 0.5)] at discharge. Overall, a great routine with the Senhance Surgical System proves good control and, thus, feasibility and safety. Therefore, the Senhance Surgical System is a viable option for total hysterectomy.

Robotic platforms in gynaecological surgery: past, present, and future

Background

More than two decades ago, the advent of robotic laparoscopic surgery marked a significant milestone, featuring the introduction of the AESOP robotic endoscope control system and the ZEUS robotic surgery system. The latter, equipped with distinct arms for the laparoscope and surgical instruments, was designed to accommodate remote connections, enabling the practice of remote telesurgery as early as 2001. Subsequent technological progress has given rise to a range of options in today's market, encompassing multi-port and single-port systems, both rigid and flexible, across various price points, with further growth anticipated.

Objective

This article serves as an indispensable guide for gynaecological surgeons with an interest in embracing robotic surgery.

Materials and methods

Drawing insights from the experience of the Strasbourg training centre for minimally invasive surgery (IRCAD), this article offers a comprehensive overview of existing robotic platforms in the market, as well as those in development.

Results

Robotic surgical systems not only streamline established operative methods but also broaden the scope of procedures, including intra- and transluminal surgeries. As integral components of the digital surgery ecosystem, these robotic systems actively contribute to the increasing integration and adoption of advanced technologies, such as artificial intelligence-based data analysis and support systems.

Conclusion

Robotic surgery is increasingly being adopted in clinical practice. With the growing number of systems available on the marketplace, the primary challenge lies in identifying the optimal platform for each specific procedure and patient. The seamless integration of robotic systems with artificial intelligence, image-guided surgery, and telesurgery presents undeniable advantages, enhancing the precision and effectiveness of surgical interventions.

What is new?

This article provides a guide to the robotic platforms available on the market and those in development for gynaecologists interested in robotic surgery.

Suitability of the MP1000 system for robot-assisted partial nephrectomy: a multicenter randomized controlled noninferiority trial

PURPOSE

This study aimed to compare the safety and effectiveness of the MP1000 surgical system with the da Vinci Si robot system in robot-assisted partial nephrectomy (RAPN) through a prospective, single-blinded, randomized controlled trial.

MATERIALS AND METHODS

A total of 62 patients who were scheduled to undergo RAPN were randomly assigned to either the da Vinci Si robot or MP1000 group. A noninferiority test was conducted with a noninferior intermediate value of 10%. The study compared installation and operation times, estimated blood loss, warm ischemia time, postoperative surgical margin, rate of conversion to open surgery, eGFR level, complications, and other safety indicators between the two groups.

RESULTS

All procedures were successfully completed without the need for conversion to open or laparoscopic surgery, and no major complications were observed during the process. The test of noninferiority was achieved. There were no significant differences in median installation time, operation time, complication rate at 3 months, rate of positive surgical margin, and eGFR level at 3 months between the groups. Additionally, no evidence of recurrence was found on imaging in both groups. No difference in National Aeronautics and Space Administration task load index results for ergonomic considerations. A limitation of this study was its small sample size.

CONCLUSIONS

The MP1000 system is a suitable platform for RAPN with safety and effectiveness compared with da Vinci Si system.

Feasibility and safety of dual-console telesurgery with the KangDuo Surgical Robot-1500 System using fifth-generation and wired networks: an animal experiment and sea-spanning clinical study

BACKGROUND

To evaluate the feasibility and safety of dual-console telesurgery with the new KangDuo system in an animal experiment and clinical study.

METHODS

Six canine models were performed radical prostatectomy with dual-console KanDuo surgical robot-1500 (KD-SR-1500-RARP). The perioperative outcomes, physical and mental workload of the surgeon were collected. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with NASA-TLX. After conducting animal experiments to verify safety of dual-console KD-SR-1500-RARP, we conducted the clinical trial using 5G and wired networks.

RESULTS

In the animal experiment, all surgeries were performed successfully. The operative time was 80.2±32.1 min. The docking time was 2.4±0.5 min. The console time was 49.7±25.3 min. There were no perioperative complications or equipment related adverse events. All dogs can micturate after catheter removal at one week postoperatively. The mental workload was at a low level (a scale ranging from 0 to 60), which scored 15.7±6.9. Among the eight recorded muscles, the fatigue degree of the right radial flexor and left biceps was the highest two (iEMG, resection, 299.8±344 uV, 109.9±16.9 uV; suture, 849.4±1252.5 uV, 423.1±621.3 uV, respectively). In the clinical study, the console time was 136 min. The mean latency time was ≤200 ms. The data pocket loss was <1%. The operation was successfully completed without malfunctions occurring throughout the entire process.

CONCLUSIONS

Dual-console telesurgery with the KD-SR-1500 system was shown to be feasible and safe in radical prostatectomy using 5G and wired networks.

Emerging multi-port soft tissue robotic systems: a systematic review of clinical outcomes

Multiple novel multi-port robotic surgical systems have been introduced into clinical practice. This systematic review aims to evaluate the clinical outcomes of these novel robotic systems to conventional laparoscopic technique and established da Vinci robotic surgical platforms. A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to the PRISMA guidelines from 2012 to May 2023. Studies comparing clinical outcomes of novel multi-port robotic surgical systems with laparoscopic or the da Vinci platforms were included. Case series with no comparison groups were excluded. Descriptive statistics were used to report patient and outcome data. A systematic narrative review was provided for each outcome. Twelve studies comprised of 1142 patients were included. A total of 6 novel multi-port robotic systems: Micro Hand S, Senhance, Revo-i MSR-5000, KangDuo, Versius, and Hugo™ RAS were compared against the laparoscopic or the da Vinci robotic platforms. Clinical outcomes of these novel robotic platforms were comparable to the established da Vinci platforms. When compared against conventional laparoscopic approaches, the robotic platforms demonstrated lower volume of blood loss, shorter length of stay but longer operative time. This systematic review highlighted the safe implementation and efficacy of 6 new robotic systems. The clinical outcomes achieved by these new robotic systems are comparable to the established da Vinci robotic system in simple to moderate case complexities. There is emerging evidence that these new robotic systems provide a viable alternative to currently available robotic platforms.

Evaluation status of current and emerging minimally invasive robotic surgical platforms

BACKGROUND

The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework.

METHODS

A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature.

RESULTS

21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0.

CONCLUSIONS

The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.

Analysis of KangDuo-SR-1500 and KangDuo-SR-2000 robotic partial nephrectomy from an operative and ergonomic perspective: a prospective controlled study in porcine models

The objective of this study is to explore the safety and effectiveness of two new models of KangDuo surgical robots for partial nephrectomy in porcine models, and evaluate the ergonomic characteristics from both subjective and objective perspectives. Twelve porcine models were equally divided for KD-SR-1500 (three-arm) and KD-SR-2000 (four-arm). The perioperative outcomes, and physical and mental workload of the surgeon were compared. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with NASA-TLX. All surgeries were performed successfully. There were no differences in perioperative variables (p > 0.05). There were no perioperative complications. The mental workload in both groups was at a low level. KD-SR-2000 showed advantages in physical workload (p < 0.01). KD-SR-1500 and KD-SR-2000 are technically feasible, valid, and safe for RAPN in porcine models. KD-SR-2000 had ergonomic advantages over KD-SR-1500.

The new surgical robot Hugo™ RAS for total hysterectomy: a pilot study

Background

With the rising popularity of robotic surgery, Hugo™ RAS is one of the newest surgical robotic platforms. Investigating the reliability of this tool is the first step toward validating its use in clinical practice; and presently there arelimited data available regarding this. The literature is constantly enriched with initial experiences, however no study has demonstrated the safety of this platform yet.

Objectives

This study aimed to investigate its reliability during total hysterectomy.

Materials and Methods

A series of 20 consecutive patients scheduled for minimally invasive total hysterectomy with or without salpingo-oophorectomy for benign disease or prophylactic surgery were selected to undergo surgery with Hugo™ RAS. Data regarding any malfunction or breakdown of the robotic system as well as intra- and post-operative complications were prospectively recorded.

Results

Fifteen of the twenty patients (75.0%) underwent surgery for benign uterine diseases, and five (25.0%) underwent prophylactic surgery. Among the entire series, an instrument fault occurred in one case (5.0%). The problem was solved in 4.8 minutes and without complications for the patient. The median total operative time was 127 min (range, 98-255 min). The median estimated blood loss was 50 mL (range:30-125 mL). No intraoperative complications were observed. One patient (5.0%) developed Clavien-Dindo grade 2 post-operative complication.

Conclusions

In this pilot study, Hugo™ RAS showed high reliability, similar to other robotic devices.

What is new?

Present findings suggest that Hugo™ RAS is a viable option for major surgical procedures and deserves further investigation in clinical practice.

Laparoscopic Photoacoustic Imaging System Based on Side-Illumination Diffusing Fibers

OBJECTIVE

To develop a flexible miniaturized photoacoustic (PA) imaging probe for detecting anatomical structures during laparoscopic surgery. The proposed probe aimed to facilitate intraoperative detection of blood vessels and nerve bundles embedded in tissue not directly visible to the operating physician to preserve these delicate and vital structures.

METHODS

We modified a commercially available ultrasound laparoscopic probe by incorporating custom-fabricated side-illumination diffusing fibers that illuminate the probe's field of view. The probe geometry, including the position and orientation of the fibers and the emission angle, was determined using computational models of light propagation in the simulation and subsequently validated through experimental studies.

RESULTS

In wire phantom studies within an optical scattering medium, the probe achieved an imaging resolution of 0.43 ±0.09 mm and a signal-to-noise ratio of 31.2±1.84 dB. We also conducted an ex vivo study using a rat model, demonstrating the successful detection of blood vessels and nerves.

CONCLUSION

Our results indicate the viability of a side-illumination diffusing fiber PA imaging system for guidance during laparoscopic surgery.

SIGNIFICANCE

The potential clinical translation of this technology could enhance the preservation of critical vascular structures and nerves, thereby minimizing post-operative complications.

Robot-assisted Partial Nephrectomy with the Newly Developed KangDuo Surgical Robot Versus the da Vinci Si Surgical System: A Double-center Prospective Randomized Controlled Noninferiority Trial

BACKGROUND

The KangDuo surgical robot (KD-SR) was recently developed in China.

OBJECTIVE

To compare the safety and efficacy of the KD-SR versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted partial nephrectomy (RAPN).

DESIGN, SETTING, AND PARTICIPANTS

A double-center prospective randomized controlled noninferiority trial of patients aged 18-75 yr with a suspicion of T1a N0M0 renal cancer (RENAL nephrometry score ≤9) was conducted.

INTERVENTION

RAPN with the KD-SR versus the DV-SS-Si.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The primary endpoint was the success rate of operation. The operation was successful if (1) there was no open or laparoscopic conversion, (2) the warm ischemia time was <30 min for RENAL nephrometry scores of 4-6 or 40 min for RENAL nephrometry scores of 7-9, and (3) the pathological margin was negative. The secondary endpoint was the estimated glomerular filtration rate (eGFR). A threshold of 10% was set to demonstrate noninferiority.

RESULTS AND LIMITATIONS

From September 2020 to March 2021, 100 participants were enrolled, of whom 99 (49 in the KD-SR group and 50 in the DV-SS-Si group) were finally included in the full analysis set and 98 (49 in the KD-SR group and -49 in the DV-SS-Si group) in the per-protocol set. Baseline demographic and clinical characteristics were similar between the two groups. All surgeries were completed successfully. The eGFR at postoperative weeks 4-12 and adverse events were similar between the two groups. The docking time and suture time per stitch were longer in the KD-SR group. The main limitation was that a negative margin was considered as the primary outcome rather than survival.

CONCLUSIONS

The KD-SR achieved noninferior outcomes as compared with the DV-SS-Si regarding safety and efficacy for T1a tumors.

PATIENT SUMMARY

The first trial comparing the KangDuo surgical robot (KD-SR) versus the da Vinci Si Surgical System for robot-assisted partial nephrectomy showed that the KD-SR is a viable option for minimally invasive treatment of T1a renal tumors.

Advanced surgical tool: Progress in clinical application of intelligent surgical robot

Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.

Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results

Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.

Robotics in laparoscopic surgery - A review

Because of the increasing use of laparoscopic surgeries, robotic technologies have been developed to overcome the challenges these surgeries impose on surgeons. This paper presents an overview of the current state of surgical robots used in laparoscopic surgeries. Four main categories were discussed: handheld laparoscopic devices, laparoscope positioning robots, master–slave teleoperated systems with dedicated consoles, and robotic training systems. A generalized control block diagram is developed to demonstrate the general control scheme for each category of surgical robots. In order to review these robotic technologies, related published works were investigated and discussed. Detailed discussions and comparison tables are presented to compare their effectiveness in laparoscopic surgeries. Each of these technologies has proved to be beneficial in laparoscopic surgeries.

Robot-assisted partial nephrectomy with a new robotic surgical system: feasibility and perioperative outcomes

PURPOSE

To evaluate the feasibility and safety of a novel robotic system (KD-SR-01) for partial nephrectomy.

METHODS

Seventeen patients with small renal mass (SRM) (≤4 cm) underwent KD-SR-01 robotic partial nephrectomy (KD-RPN) from December 2020 to March 2021 in our institution. The operative outcomes and perioperative data, including clinical and histological data, were prospectively collected and analyzed.

RESULTS

In total, 10 men and 7 women, with a median age of 51 years, underwent KD-RPN. Four transperitoneal procedures and 13 retroperitoneal procedures were successfully performed without conversion to open or conventional laparoscopic surgery. The docking time and robotic operative time were 3.3 min and 68.6 min, respectively. The warm ischemia time was 16.9 min. No major intraoperative or postoperative complications (Clavien grade ≥ III) occurred. The duration of postoperative hospital stay was 5 days. Pathologic examination revealed nine clear cell carcinomas, two papillary cell carcinomas, one oncocytoma, and five angiomyolipoma. All surgical margins were negative. The estimated globular filtration rate (eGFR) on the 1st postoperative day was significantly decreased compared to the preoperative eGFR (91.7±12.9 ml/min vs. 97.9±10.7 ml/min, P =0.036). However, no significant difference was observed between the preoperative eGFR and the value on the 4th postoperative day (95.7±13.4 ml/min vs. 97.9±10.7 ml/min, P=0.427).

CONCLUSION

KD-RPN was safe and feasible for the treatment of SRM. The early oncologic and functional outcomes were promising. Long-term follow-up and well-designed prospective comparative studies with the da Vinci platform are needed to corroborate these findings.

Assessment of the Versius Robotic Surgical System in Minimal Access Surgery: A Systematic Review

Background: Despite the superiority of minimal access surgery (MAS) over open surgery, MAS is difficult to perform and has a demanding learning curve. Robot-assisted surgery is an advanced form of MAS. The Versius® surgical robot system was developed with the aim of overcoming some of the challenges associated with existing surgical robots. The present study was designed to investigate the feasibility, clinical safety, and effectiveness of the Versius system in MAS. Materials and Methods: A comprehensive search was carried out in the Medline, Web of Science Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan), and Scopus databases for articles published until February 2022. The keywords used were Versius robot, visceral, colorectal, gynecology, and urologic surgeries. Articles on the use of the Versius robot in minimal access surgery (MAS) were included in the review. Results: Seventeen articles were reviewed for the study. The investigation comprised a total of 328 patients who had been operated on with this robot system, of which 48.3%, 14.2%, and 37.5% underwent colorectal, visceral, and gynecological procedures, respectively. Postoperative and major complications within 30 days varied from 7.4% to 39%. No major complications and no readmissions or reoperations were reported in visceral and gynecological surgeries. Readmission and reoperation rates in colorectal surgeries were 0–9%. Some procedures required conversion to conventional laparoscopic surgery (CLS) or open surgery, and all procedures were completed successfully. Based on the studies reviewed in the present report, we conclude that the Versius robot can be used safely and effectively in MAS. Conclusions: A review of the published literature revealed that the Versius system is safe and effective in minimal access surgery. However, the data should be viewed with caution until randomized controlled trials (RCTs) have been performed. Studies on the use of this robotic system in oncological surgery must include survival as one of the addressed outcomes.

Introducing the New Surgical Robot HUGO™ RAS: System Description and Docking Settings for Gynecological Surgery

This study provides a detailed description of the new HUGO™ RAS System and suggests docking settings for gynecological surgery. The system is composed of an "open" surgical console with an HD-3D passive display, a system tower, and four arm carts. Each arm has an extremely wide range of adaptability resulting from the numerous joints. The human cadaver labs were performed at the ORSI Academy between August and December 2021. All procedures were performed by two surgical teams, each composed of a high-volume surgeon experienced in robotic surgery, gynecologic oncology, and pelvic sidewall surgery, and one bedside assistant. Three main gynecological surgical scenarios were identified: standard pelvic surgery, pelvic sidewall surgery, and para-aortic/upper abdominal surgery. Concerning the port placement, the chosen options were called "straight" and "bridge"; instead, the so-called "compact" and "butterfly" configurations were identified for the arm cart positioning. Four cadavers were used to perform total hysterectomy, radical hysterectomy, pelvic exenteration, pelvic and para-aortic lymphadenectomy, and omentectomy. We performed several tests, identifying the best system configurations to draw the proper efficiency from the flexibility of the system in all gynecological surgical scenarios. The straight port placement seems to be adequate for standard pelvic surgery. The bridge trocar position is best to reach the deeper and lateral anatomical regions of the female pelvis. The compact and butterfly arm cart allocations are adequate for both straight and bridge port placement. When deep pelvic surgery was performed, the bedside assistant became more proficient by working with a standard laparoscopic instrument from an ancillary port placed in the left iliac fossa. The arm carts needed to be moved in an open manner, like for the proposed butterfly configuration. On the contrary, the compact disposition left enough space to assist from Palmer's point port. Several basic and advanced gynecological surgical procedures were performed and completed successfully without encountering any technical or surgical issue, the results obtained were judged sufficient to proceed with the clinical experience in daily practice. The HUGO™ RAS system is flexible and highly performative in various surgical scenarios.

The first European gynaecological procedure with the new surgical robot Hugo™ RAS. A total hysterectomy and salpingo-oophorectomy in a woman affected by BRCA-1 mutation

Background

The benefits of minimally invasive surgery are well known in gynaecology. Robotic-assisted surgery has gained widespread acceptance within the surgical community and seems to be the most rapidly developing sector of minimally invasive surgery.

Objectives

This video shows the salient steps of total hysterectomy with new robotic technology, Hugo™ RAS. The objectives were to introduce and demonstrate the feasibility, efficacy, and safety of this new advanced device.

Materials and Methods

A sixty-two years-old woman affected by BRCA-1 mutation underwent the first European gynaecological surgical procedure using the new surgical robot Hugo™ RAS in the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Main outcome measures

Docking and operative times.

Results

The docking time was 6 minutes and the total operative time was 58 minutes. There were no system errors and faults in the robotic arms. The surgeon found no friction or rasping in the arms. The estimated blood loss was 30 mL. No intraoperative complications were recorded.

Conclusion

Gynaecological surgery with Hugo™ RAS seems feasible, safe and effective as shown by initial experiences in urological surgery. A larger case series would confirm the current experience and determine whether this technology could offer any additional benefit.

Partial nephrectomy through retroperitoneal approach with a new surgical robot system, KD-SR-01

BACKGROUND

To present our experiences with partial nephrectomy (PN) through retroperitoneal approach (RP) with the Kangduo robotic system.

METHODS

From December 2020 to February 2021, the perioperative data of 11 patients underwent PN through RP with the Kangduo robotic system were collected prospectively.

RESULTS

For the R.E.N.A.L. nephrometry score, 72.7% of patients had a low score (4-6) and 27.3% of patients had a medium score (7-9). Seven tumours were posterior (P), four tumours were on the midline (X). All procedures were completed successfully. The median warm ischemia time was 18.5 (IQR, 13.7-21.0) min. None of the patients had positive surgical margins at definitive histology (all pT1a). No high-grade perioperative complications or device-related adverse events occurred. At a mean follow-up of 8 ± 0.8 months, no complications occurred in all patients.

CONCLUSIONS

RPPN using the novel Kangduo robotic system is a safe and effective option for managing posterior and lateral renal tumours with R.E.N.A.L. nephrometry scores ≤9.

Potential Contenders for the Leadership in Robotic Surgery

Purpose: To summarize the scientific published literature on new robotic surgical platforms with potential use in the urological field, reviewing their evolution from presentation until the present day. Our goal is to describe the current characteristics and possible prospects for these platforms. Materials and Methods: A nonsystematic search of the PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases was conducted to identify scientific literature about new robotic platforms other than the Da Vinci^® system, reviewing their evolution from inception until December 2020. Only English language publications were included. The following keywords were used: "new robotic platforms," "Revo-I robot," "Versius robot," and "Senhance robot." All relevant English-language original studies were analyzed by one author (R.F.) and summarized after discussion with an independent third party (E.M., S.Y., S.P., and M.A.). Results: Since 1995, Intuitive Surgical, Inc., with the Da Vinci surgical system, is the leading company in the robotic surgical market. However, Revo-I^®, Versius^®, and Senhance^® are the other three platforms that recently appeared on the market with available articles published in peer-reviewed journals. Among these three new surgical systems, the Senhance robot has the most substantial scientific proof of its capacity to perform minimally invasive urological surgery and as such, it might become a contender of the Da Vinci robot. Conclusions: The Da Vinci surgical platform has allowed the diffusion of robotic surgery worldwide and showed the different advantages of this type of technique. However, its use has some drawbacks, especially its price. New robotic platforms characterized by unique features are under development. Of note, they might be less expensive compared with the Da Vinci robotic system. We found that these new platforms are still at the beginning of their technical and scientific validation. However, the Senhance robot is in a more advanced stage, with clinical studies supporting its full implementation.

The TransEnterix European Patient Registry for Robotic-Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery ("TRUST")

INTRODUCTION

Robotic surgery was first introduced in the mid-1980s, and at the end of the '90s, the da Vinci® System (Intuitive Surgical Inc., Sunnyvale, California) was introduced in Europe and held a monopoly for years afterward. In 2016, Senhance™ digital laparoscopic platform (TransEnterix Inc., Morrisville, North Carolina) came to the market. This new platform is based on laparoscopic movements and is designed for laparoscopic surgeons. This study shows the surgical outcomes of patients after different visceral, colorectal, gynecological, and urological surgical procedures done with the Senhance™ digital laparoscopic platform with a focus on safety.

MATERIALS AND METHODS

The study population consists of 871 patients who underwent robotic surgery with the Senhance™ platform. The most common procedures were hernia repairs (unilateral and bilateral), cholecystectomies, and prostatectomies. The procedures were performed in five centers in Europe between February 2017 and July 2020 by experienced laparoscopic surgeons.

RESULTS

220 (25.3 %) out of 871 patients had a unilateral hernia repair, 70 (8.0%) a bilateral hernia repair, 159 (18.3%) underwent a cholecystectomy, and 168 (19.3%) a prostatectomy. The other procedures included visceral, colorectal, and gynecological surgery procedures. The median docking time was 7.46 minutes for the four most common procedures. The duration of surgery varied from 32 to 313 minutes, the average time was 114.31 minutes. Adverse events were rare overall. There were 48 (5.5 %) adverse events out of 871 patients, 24 of them (2.8 % of all cases) were severe. Out of all 24 severe adverse events, five events (20.8%) were likely related to the robot, 17 events (70.8%) were unlikely related to the robot, and two events (8.3%) could not be categorized. Regarding complications following unilateral hernia repairs, data from 212 patients was available. Thirteen (6.1%) complications occurred, and six of those (2.8%) were serious. Out of 68 patients with a bilateral hernia repair, six patients (8.8%) developed complications, three of which were severe (4.4%). The complication rate was 2.8% in the patients following a cholecystectomy (4/144); two of them serious. After prostatectomy, six out of 141 patients (4.3 %) had complications; one serious (0.7%) No mortality was observed. Data about unplanned conversions to laparoscopic surgery could be collected from 761 patients which is a rate of 3.7%. There were 12 conversions out of 760 procedures to open surgery (1.6%).

CONCLUSIONS

Our series shows these procedures are safe and reproducible. The findings suggest that the surgical results after robotic surgery with the Senhance™ system are promising. Long-term data regarding complication rates should be the subject of future studies.

Updates and Controversies of Robotic-Assisted Surgery in Gynecologic Surgery

minimally invasive surgery (MIS) is the standard approach to performance of several gynecologic procedures, including hysterectomy, gynecologic cancer staging procedures, myomectomy, pelvic organ prolapse repair, and select adnexal procedures. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with other MIS approaches. This review critically appraises the evolving role, benefits, limitations, and controversies of robotic-assisted surgery utilization in benign and oncologic gynecology settings.

5G ultra-remote robot-assisted laparoscopic surgery in China

BACKGROUND

5G communication technology has been applied to several fields in telemedicine, but its effectiveness, safety, and stability in remote laparoscopic telesurgery have not been established. Here, we conducted four ultra-remote laparoscopic surgeries on a swine model under the 5G network. The aim of the study was to investigate the effectiveness, safety, and stability of the 5G network in remote laparoscopic telesurgery.

METHODS

Four ultra-remote laparoscopic surgeries (network communication distance of nearly 3000 km), including left nephrectomy, partial hepatectomy, cholecystectomy, and cystectomy, were performed on a swine model with a 5G wireless network connection using a domestically produced "MicroHand" surgical robot. The average network delay, operative time, blood loss, and intraoperative complications were recorded.

RESULTS

Four laparoscopic telesurgeries were safely performed through a 5G network, with an average network delay of 264 ms (including a mean round-trip transporting delay of 114 ms and a 1.20% data packet loss ratio). The total operation time was 2 h. The total blood loss was 25 ml, and no complications occurred during the procedures.

CONCLUSIONS

Ultra-remote laparoscopic surgery can be performed safely and smoothly with 5G wireless network connection using domestically produced equipment. More importantly, our model can provide insights for promoting the future development of telesurgery, especially in areas where Internet cables are difficult to lay or cannot be laid.

First experience of pancreaticoduodenectomy using Revo-i in a patient with insulinoma

Robotic surgery systems have been developed to overcome the limitations of laparoscopic surgery. Recently, Meerecompany Inc. in Korea successfully manufactured a robotic surgical system called Revo-i. A 65-year old woman was referred for a pancreatic head tumor, detected as an incidental finding during a routine check-up. Contrast abdominopelvic CT revealed a pancreatic uncinate tumor measuring around 13 mm in diameter, with no other focal lesions. The patient underwent a robot-assisted pancreaticoduodenectomy (laparoscopic resection and robotic reconstruction) using Revo-i. The patient's recovery was uneventful and discharged on postoperative day 7. Our case showed the technical feasibility of the Korean robotic surgical system Revo-i. Further experiences are mandatory to validate this finding.

Initial Experience With a New Robotic Surgical System for Cholecystectomy

Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance^™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.

Robotic surgery using Senhance® robotic platform: single center experience with first 100 cases

Until recently, robotic surgery has been associated only with the da Vinci robotic system. A novel Senhance^® robotic system (TransEnterix Surgical Inc., Morrisville, NC, USA) was introduced almost 5 years ago. Published reports on experience using this robotic platform are very limited. We present a prospective analysis of the first 100 robotic surgeries in abdominal surgery, gynecology, and urology in Klaipeda University Hospital, Klaipeda, Lithuania. Out of 100 operated patients during the mentioned period, 49 were female and 51 men, age range 27-79 years, on an average 55 years. 39 underwent robotic abdominal surgical procedures, 31-urological, and 30 gynecological surgeries. Duration of surgery varied from 30 min to 6 h and 5 min, on an average 2 h 25 min. Almost half 49 (49%) were operated on for malignant diseases: prostate cancer-27, renal cell carcinoma-1, endometrial cancer-7, ovarian cancer-1, colorectal cancer-13 (7 colon and 6 rectum). In-hospital stay was on an average 4 days, range 1-15 days. There were 3 (3%) conversions: two to laparoscopy (both undergoing robotic radical prostatectomy) and one to open (undergoing total hysterectomy). 6 (6%) complications occurred during 30 postoperative days, 2 demanding surgery. According to the Clavien-Dido classification, they were grade II in 3, grade III a in 1 and grade III b in 2 cases. There was no mortality in this patient population. Our experience with different types of robotic surgeries allows us to state that the Senhance^® robotic system is feasible and safe in general surgery, gynecology, and urology, and wider implementation of this system worldwide is simply a question of time.

The Future of Robotic Surgery in Pediatric Urology: Upcoming Technology and Evolution Within the Field

Since the introduction of the Da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) in 1999, the market for robot assisted laparoscopic surgery has grown with urology. The initial surgical advantage seen in adults was for robotic prostatectomy, and over time this expanded to the pediatric population with robotic pyeloplasty. The introduction of three-dimensional visualization, tremor elimination, a 4th arm, and 7-degree range of motion allowed a significant operator advantage over laparoscopy, especially for anastomotic suturing. After starting with pyeloplasty, the use of robotic technology with pediatric urology has expanded to include ureteral reimplantation and even more complex reconstructive procedures, such as enterocystoplasty, appendicovesicostomy, and bladder neck reconstruction. However, limitations of the Da Vinci Surgical Systems still exist despite its continued technological advances over multiple generations in the past 20 years. Due to the smaller pediatric market, less focus appears to have been placed on the development of the smaller 5 mm instruments. As pediatric urology continues to utilize robotic technology for minimally invasive surgery, there is hope that additional pediatric-friendly instruments and components will be developed, either by Intuitive Surgical or one of the new robotic platforms in development that are working to address many of the shortcomings of current systems. These new robotic platforms include improved haptic feedback systems, flexible scopes, easier maneuverability, and even adaptive machine learning concepts to bring robotic assisted laparoscopic surgery to the next level. In this report, we review the present and upcoming technological advances of the current Da Vinci surgical systems as well as various new robotic platforms, each offering a unique set of technological advantages. As technology progresses, the understanding of and access to these new robotic platforms will help guide pediatric urologists into the next forefront of minimally invasive surgery.

Robots in laparoscopic surgery: current and future status

In this paper, we focus on robots used for laparoscopic surgery, which is one of the most active areas for research and development of surgical robots. We introduce research and development of laparoscope-holder robots, master-slave robots and hand-held robotic forceps. Then, we discuss future directions for surgical robots. For robot hardware, snake like flexible mechanisms for single-port access surgery (SPA) and NOTES (Natural Orifice Transluminal Endoscopic Surgery) and applications of soft robotics are actively used. On the software side, research such as automation of surgical procedures using machine learning is one of the hot topics.

Senhance robotic platform for gynecologic surgery: a review of literature

The advantages of endoscopic procedures are well demonstrated in various surgical procedures. In this field, the technological improvement has been significant. One of the most relevant was made by the introduction of robotic surgery that, thanks to the instruments articulation and the precision of movement, made possible to perform even the most complex procedures. The terms "Alf-X" OR "Senhance" OR "robot" OR "robotic" were systematically used to search the PubMed and Scopus databases. The principal findings considered in the present review were: the study design, the number of patients included in each study, operative time, estimated blood loss (EBL), conversion rate to standard laparoscopy (SLPS) or laparotomy (LPT), post-operative complications, post-operative hospital stay, and the possible advantages and disadvantages reported by the authors of the studies. A total of eight studies were considered eligible for the present review. The average operative time for TH reported was 110-140 min. In two case-control studies, the operative time was significantly prolonged (P < 0.05) for robotic procedures when compared with SLPS. The EBL was ≤ 100 ml in all studies. Whereas no statistically significant differences were shown in the two case-control studies in terms of conversion to LPT, all studies were in accordance with the post-operative hospital stay, reporting an average of 2 days for total hysterectomy and 1 day for adnexal surgery.

Objective Assessment of the Early Stages of the Learning Curve for the Senhance Surgical Robotic System

OBJECTIVE

The purpose of this research is to study the early stages of the Senhance learning curve to report how force feedback impacts learning rate. This serves as an exploratory investigation into assumptions that fellows and faculty will adjust faster to the Senhance in comparison with residents, and that force feedback will not hinder skill acquisition.

DESIGN

In this study, participants completed the peg transfer and precision cutting task from the Fundamentals of Laparoscopic Surgery (FLS) manual skills assessment five times each using the Senhance while instrument motion was tracked.

SETTING

This study took place in the Surgical Education and Activities Laboratory at Duke University Medical Center.

PARTICIPANTS

Participants for this study were residents, fellows, and faculty from Duke University Medical Center in general surgery and gynecology specialties (N = 16).

RESULTS

Postulated linear mixed effects models with participant level random effects showed significant improvement with additional attempts for the peg transfer task after adjusting for surgical experience and force feedback respectively for the primary FLS score metric. The secondary metric of total instrument path length also showed improvement (significant decreases) in path length with additional attempts after respectively adjusting for surgical experience and force feedback.

CONCLUSIONS

This study investigates the early stages of the learning curve of the Senhance. Exploratory modeling indicates that residents, fellows, and faculty surgeons rapidly adapt to the controls of the Senhance regardless of experience level and force feedback engagement. The results from this study may serve as motivation for future prospective studies that achieve sufficient statistical power with a larger sample size and strict experimental design.

Master-slave motion alignment for an open surgical console

BACKGROUND

Open surgical consoles widely employed in minimally invasive surgery have better ergonomics than closed consoles. To enhance surgical robots' ergonomics, operational efficiency, and safety, an effective master-slave motion alignment model should be established.

METHODS

The kinematic model of the robot system based on laparoscopic camera coordinate system is built in the first place. Then, the relative pose between the operator's eyes and the display is measured by Tobii Eye Tracking Sensor and is subsequently used to improve the master-slave motion alignment model.

RESULTS

Robot threading experiments are conducted by two doctors and three testers to verify the kinematic model. As a result, in contrast to the original model, the improved model reduces both operation time and the number of collisions.

CONCLUSIONS

The improved master-slave motion alignment model, in which the transformation matrix between the operator's eyes and the display is employed, raises the ergonomics, operational efficiency, and safety.

New era of robotic surgical systems

INTRODUCTION

To provide an update on the current status of robotic systems for surgery and the companies that produce these systems.

METHODS

A non-systematic literature review was performed by using the PubMED/MEDLINE electronic search engines. Existing patents for robotic companies and devices were researched by using the Google search engine.

RESULTS

Since the da Vinci Surgical System's patent expired, we have been able to predict the future of robotic companies based on the various robotic systems being developed. Currently, various attempts are being made to create consoles, robotic arms, cameras, handles, and instruments and to implement specific functions (e.g. haptic feedback, eye tracking). Herein, the benefits and limitations of each technology are identified, and likely future developments are described.

CONCLUSIONS

The robotic surgical systems are continually being developed by various companies around the world. New technologies have been increasingly implemented to improve on the capabilities of previously established systems and surgical ergonomics. Future studies may need to evaluate the strengths and weaknesses of each robotic surgical system.

Robotic-assisted surgery for rectal cancer: Current state and future perspective

Interest in minimally invasive surgery has increased in recent decades. Robotic-assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual-console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.

Minimally Invasive Surgery in Pediatric Urology: Adaptations and New Frontiers

As the frontiers of minimally invasive surgery (MIS) continue to expand, the availability and implementation of new technology in pediatric urology are increasing. MIS is already an integral part of pediatric urology, but there is still much more potential change to come as both recent and upcoming advances in laparoscopic and robotic surgery are surveyed.

Review of emerging surgical robotic technology

BACKGROUND

The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development.

METHODS

This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described.

RESULTS

A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot.

CONCLUSIONS

The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.

Novel robotic systems and future directions

Robot-assistance is increasingly used in surgical practice. We performed a nonsystematic literature review using PubMed/MEDLINE and Google for robotic surgical systems and compiled information on their current status. We also used this information to predict future about the direction of robotic systems based on various robotic systems currently being developed. Currently, various modifications are being made in the consoles, robotic arms, cameras, handles and instruments, and other specific functions (haptic feedback and eye tracking) that make up the robotic surgery system. In addition, research for automated surgery is actively being carried out. The development of future robots will be directed to decrease the number of incisions and improve precision. With the advent of artificial intelligence, a more practical form of robotic surgery system can be introduced and will ultimately lead to the development of automated robotic surgery system.

First experience in colorectal surgery with a new robotic platform with haptic feedback

The use of robotic techniques is increasing in colorectal surgery. Recently, the Senhance™ surgical robotic system was introduced as a novel robotic platform designed to overcome some of the limits of standard laparoscopy. This study describes the initial, single center experience, evaluating feasibility and safety of the new robotic system in performing colorectal surgical procedures.

METHODS

From June 2015 to November 2016, perioperative data of the first 45 patients who underwent robotic colorectal surgery with the SenhanceTM surgical robotic system were collected and analyzed. Indications for surgery included inflammatory bowel disease, colorectal cancer, endoscopically unresectable adenomas and complicated diverticular disease.

RESULTS

The median age was 57 years (18-92) and the median BMI was 24 Kg/m2 (16-30). Surgical indications were colorectal cancer (66%), complicated inflammatory bowel disease (18%), diverticular disease (11%) and endoscopically unresectable adenoma (4.4%). The median operative time was 256 minutes; the median docking time 10.7 min (range 2-25). There were 3 conversions to standard laparoscopy, and none to laparotomy. All patients operated on for malignancy (28 adenocarcinoma, 2 neuroendocrine tumors) underwent an appropriate oncological procedure. The median time to discharge was 5 days (range 3-19). The incidence of post-operative complications was 35.5% (Clavien-Dindo I/II-14 patients, III-2 patients). One patient was readmitted in the postoperative period. No patient required reoperation.

CONCLUSION

The results of this audit suggest that adoption of The Senhance™ surgical robotic system in colorectal surgery is feasible and safe. More clinical data are needed to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques. This article is protected by copyright. All rights reserved.

The Senhance™ surgical robotic system ("Senhance") for total hysterectomy in obese patients: a pilot study

This pilot study was aimed to value the feasibility and safety of Senhance Robotic Platform for hysterectomy in obese patients. Ten obese patients (30 < BMI < 40) underwent elective Senhance total extrafascial hysterectomy with bilateral salpingo-oophorectomy at the Division of Gynecologic Oncology of "Policlinico A. Gemelli" Foundation, Rome, Italy. Perioperative and postoperative outcomes data were recorded. The median age was 60 years (range 51-75) and the median BMI was 33.3 kg/m² (range 30.4-38.3). The median uterine weight was 112.5 g (range 77-225). Indication to total hysterectomy was early-stage (FIGO Stage IA) endometrial cancer in 100% of patients. The median operative time (OT) was 110 min (70-200). The median docking time was 10.5 min (5-25). The median estimated blood loss was 100 mL (50-200). No conversions to laparotomy were recorded. No intra- and 30-day postoperative complications were registered. The median ileus was 17 h (12-36) and the median time to discharge was 2 days (1-4). The median VAS scores registered at 2, 4, 12, and 24 h were, respectively, 2 (1-3), 2 (1-3), 4 (1-8), and 3 (1-5). Our study results suggest that Senhance platform could be safe for hysterectomy even in obese patients. More clinical data are needed to determine whether this approach would offer any additional benefits in a new middle line between standard laparoscopy and robotics.

A single port surgical robot system with novel elbow joint mechanism for high force transmission

BACKGROUND

Despite its evident clinical benefits, single-incision laparoscopic surgery (SILS) imposes inherent limitations of collision between external arms and inadequate triangulation because multiple instruments are inserted through a single port at the same time.

METHODS

A robot platform appropriate for SILS was developed wherein an elbowed instrument can be equipped to easily create surgical triangulation without the interference of robot arms. A novel joint mechanism for a surgical instrument actuated by a rigid link was designed for high torque transmission capability.

RESULTS

The feasibility and effectiveness of the robot was checked through three kinds of preliminary tests: payload, block transfer, and ex vivo test. Measurements showed that the proposed robot has a payload capability >15 N with 7 mm diameter.

CONCLUSIONS

The proposed robot is effective and appropriate for SILS, overcoming inadequate triangulation and improving workspace and traction force capability.

Robotic cholecystectomy using Revo-i Model MSR-5000, the newly developed Korean robotic surgical system: a preclinical study

BACKGROUND

Laparoscopic surgery has become the standard option for gastrointestinal surgeries. However, laparoscopic procedures require extended training times and are difficult for inexperienced surgeons. Robot-assisted laparoscopic surgery facilitates easy adaptation of laparoscopic procedures, but robotic surgical systems are expensive. In addition, their cost has remained high because there is currently only one manufacturer of commercially available systems. Recently, a new Korean robotic surgical system, Revo-i, has been developed. The aim of this study was to evaluate the feasibility and safety of Revo-i by performing robotic cholecystectomy in a porcine model.

METHODS

After approval by the Institutional Animal Care and Use Committee of Yonsei University Health System, cholecystectomy was performed in four pigs using the Revo-i robotic surgical system. Operative time and perioperative complications were recorded, and all animals were observed for postoperative complications for 2 weeks after surgery RESULTS: Robotic cholecystectomy was completed successfully and without gallbladder perforation in all cases. The mean operative time was 78 ± 12 min, the mean docking time was 4.5 ± 2.52 min, and the mean console time was 49.8 ± 14.17 min. There were no perioperative complications, and none of the animal used for the in vivo models exhibited abnormal behavior during the postoperative observation period.

CONCLUSIONS

These preliminary results verify the safety and efficacy of robotic cholecystectomy using the Revo-i robotic surgical system. Human trials are slated to begin accordingly.

Robotics in Colorectal Surgery

Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.

Total Laparoscopic (S-LPS) versus TELELAP ALF-X Robotic-Assisted Hysterectomy: A Case-Control Study

STUDY OBJECTIVE

To compare the feasibility and safety of the TELELAP ALF-X system and standard laparoscopy for total hysterectomy to treat patients with benign and early malignant gynecologic disease.

DESIGN

Single-institution retrospective case-control study (Canadian Task Force classification II-2).

SETTING

Catholic University of the Sacred Heart, Rome, Italy.

PATIENTS

Between October 2013 and May 2015, 203 women underwent TELELAP-ALF X (group 1) or standard laparoscopic (group 2) total hysterectomy and were enrolled.

INTERVENTIONS

Total standard laparoscopy vs TELELAP ALF-X robot-assisted hysterectomy for benign and early malignant gynecologic disease.

MEASUREMENTS AND MAIN RESULTS

In group 1, the median age was 55 years (range, 40-79 years), median body mass index (BMI) was 25 kg/m(2) (range, 17-38 kg/m(2)), and 51 patients (58%) had undergone previous abdominal surgery. In the control group, the median age was 55 years (range, 34-90 years), median BMI was 25 kg/m(2) (range, 17-41 kg/m(2)), and 31 patients (27%) had previous abdominal surgery. The median operative time was 147 minutes (range, 58-320 minutes) in group 1 and 80 minutes (range, 22-300 minutes) in group 2 (p = .055). The median estimated blood loss was 57 mL (range, 0-600 mL) in group 1 and 99 mL (range, 0-400 mL) in group 2, with no significant differences between the 2 groups (p = .963). Procedures were successfully performed without conversion in 94.3% of cases in the group 1 and in all cases in group 2. Early postoperative pain was significantly lower in group 2.

CONCLUSION

TELELAP ALF-X hysterectomy in patients with benign and early malignant gynecologic disease is feasible and safe, and can be considered a valid option for these patients.