Robot-assisted Surgery System Research Articles

Safety and Efficacy of a Novel Miniaturized Robotic Assisted Surgery System in Colectomy: A Prospective, Investigational Device Exemption Clinical Study Using the IDEAL Framework.

Robotics has increased rates of minimally invasive surgery, with distinct advantages over open surgery. However, current commercially available robotic platforms have device and system issues that limit robot-assisted surgery expansion. To demonstrate the safety and efficacy of a novel miniaturized robotic assisted surgery device in colectomy. Prospective, Investigational Device Exemption clinical study following the idea, development, exploration, assessment, and long-term follow-up (IDEAL) framework (Stage 2b, exploration). Three centers with high-volume robotic colorectal cases and surgeons. Patients scheduled for a right or left colectomy for benign or malignant disease. Colectomy with the novel miniaturized robotic assisted surgery device. For safety, intraoperative and device-related adverse events and 30-day morbidity. For efficacy, successful completion of pre-defined procedural steps without conversion. Thirty patients (13 female, 17 male) were analyzed. The mean age was 59.4 (SD 13.4) years. Seventy percent (n = 21) were overweight/obese and 53.3% (n = 16) had prior abdominal surgery. Forty percent had malignant and 60% benign disease. Cases were 15 right and 15 left colectomies. Overall operative time was median 146 (range, 80-309) minutes; 70 (range, 34-174) minutes was console time. There were no conversions to open surgery, and no intraoperative or device-related adverse events. In 100% (n = 30), the primary dissection was completed, and hemostasis maintained with the novel miniaturized robotic assisted surgery device. The morbidity rate was 26.7% minor and 3.3% major. The median length of stay was 2 days. There were no mortalities. Single arm study, short-term follow-up. This first clinical study of a novel miniaturized robotic-assisted surgery device along the IDEAL framework demonstrated it was safe and effective. Given this success, further assessment and long-term follow-up of the miniaturized robotic assisted surgery device are planned for comparative clinical and economic effectiveness in colorectal surgery. See Video.

Robotic transabdominal preperitoneal mesh repair of an inguinal hernia using the HugoTM Robotic Assisted Surgery system—a case report of the first Australian clinical experience in general surgery

Robotic transabdominal preperitoneal mesh repair of an inguinal hernia using the HugoTM Robotic Assisted Surgery system—a case report of the first Australian clinical experience in general surgery

First worldwide report on rectal resections with Hugo™ surgical system: description of docking angles and tips for an effective setup.

Rectal robotic surgery gained momentum in the last decade, but it is still associated with not-negligible costs. In order to reduce costs, recently different robotic systems have received approval for clinical use. This study aims to present the first case series of rectal resection with the novel cost-effective platform Robotic Assisted Surgery (RAS) Hugo™. Tips for effective set up of the system and detailed configuration of tilt and docking angles are also provided. Three cases of rectal resection with Hugo RAS™ system are reported. After the first two cases of resection with partial mesorectal excision in which surgeries were performed with the setup proposed by the vendor company, in the third case we tested a novel setup that allowed a full robotic low rectal resection performing vascular ligations, TME and colonic splenic flexure mobilization without the need of any de-docking. Our first three robotic rectal resections with the Hugo RAS™ system were completed without complications with a median docking time of 12 min (range 8-15) and a median console time of 345 minutes (range 271-475). In the first two cases, hybrid robotic and laparoscopic surgeries were performed to obtain an adequate haemostasis and traction during the pelvic phase. In the third case, a full robotic TME was successfully accomplished. Our experience demonstrates that a full robotic low rectal resection with TME with Hugo™ RAS system is feasible, safe and associated with satisfactory postoperative outcomes.

Robot-Assisted Radical Prostatectomy by the Hugo Robotic-Assisted Surgery (RAS) System and the da Vinci System: A Comparison between the Two Platforms.

In a previous study, we proved that an experienced urologist is more likely to adapt to the Hugo RAS system. Based on this, we further examine various parameters in this study. Parameters included in this study consisted of console time, functional outcomes, and oncological outcomes. A total of 60 patients who underwent robot-assisted radical prostatectomy (RARP) performed by a single surgeon using the da Vinci (DV) system (n = 30) or the Hugo RAS system (n = 30) between March 2023 and August 2023 were included in the analysis. The intraoperative operative time was categorized into vesicourethral anastomosis time and overall console time. Functional and oncological outcomes were documented at the 1st and 3rd postoperative months. Parametric and non-parametric methods were adopted after checking skewness and kurtosis, and an α value of 5% was used to determine the significance. The vesicourethral anastomosis time was significantly lengthened (Hedge's g: 0.87; 95% confidence interval (CI): 0.34-1.39; J factor = 0.987). However, the overall console time was not affected. The functional (postoperative 3rd month: p = 0.130) and oncological outcomes (postoperative 3rd month: p = 0.103) were not significantly different. We also found that the adverse effect on surgical specimens and positive surgical margins was not affected (p = 0.552). During the process of adaptation, although intricate motions (such as the vesicourethral anastomosis time) would be lengthened, the overall console time would not change remarkably. In this process, the functional and oncological outcomes would not be compromised. This encourages urologists to adopt the Hugo RAS system in RARP if they have previous experiences of using the DV system, since their trifecta advantage would not be compromised.

Analyzing the influence of expanding multispecialty adoption of robotic surgery on robotic urologic care: A decade-long assessment of two Canadian academic hospitals.

Most robot-assisted surgery (RAS) systems in Canada are donor-funded, with constraints on implementation and access due to significant costs, among other factors. Herein, we evaluated the impact of the growing multispecialty use of RAS on urologic RAS access and outcomes in the past decade. We conducted a retrospective review of all RAS performed by different surgical specialties in two high-volume academic hospitals between 2010 and 2019 (prior to the COVID pandemic). The assessed outcomes included the effect of increased robot access over the years on annual robotic-assisted radical prostatectomy (RARP) volumes, surgical waiting times (SWT), and pathologically positive surgical margins (PSM). Data were collected and analyzed from the robotic system and hospital databases. In total, six specialties (urology, gynecology, general, cardiac, thoracic, and otorhinolaryngologic surgery) were included over the study period. RAS access by specialty doubled since 2010 (from three to six). The number of active robotic surgeons tripled from seven surgeons in 2010 to 20 surgeons in 2019. Moreover, there was a significant drop in average case volume, from a peak of 40 cases in 2014 to 25 cases in 2019 (p=0.02). RARP annual case volume followed a similar pattern, reaching a maximum of 166 cases in 2014, then declining to 137 cases in 2019. The mean SWT was substantially increased from 52 days in 2014 to 73 days in 2019; however, PSM rates were not affected by the reduction in surgical volumes (p<0.05). Over the last decade, RAS access by specialty has increased at two Canadian academic centers due to growing multispecialty use. As there was a fixed, single-robotic system at each of the hospital centers, there was a substantial reduction in the number of RAS performed per surgeon over time, as well as a gradual increase in the SWT. The current low number of available robots and unsustainable funding resources may hinder universal patient access to RAS.

The new robotic system HUGO RAS for gynecologic surgery: First European experience from Gemelli Hospital.

To evaluate the safety and feasibility of the new surgical robot HUGO robotic assisted surgery (RAS) in a series of gynecologic surgical procedures. Between March and October 2022, 138 patients treated at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy were enrolled in the study. All patients suitable for a minimally-invasive approach were prospectively included and divided into two groups: Group 1 (78 patients) made up of patients operated on for uterine and/or adnexal pathologies, and Group 2 (60 patients) made up of patients treated for pelvic organ prolapse. In Group 1, median docking time (DT) was 5 min and median console time (CT) was 90 min. In two patients (2.6%) redocking was necessary. In two patients (2.6%), the surgeon continued the surgery laparoscopically. Intraoperative complications occurred in two surgeries (2.6%). In Group 2, median DT was 4 min and median CT was 134.5 min. In three patients (5%), redocking was necessary. In all patients, the surgery was successfully completed robotically without intraoperative complications. The present study demonstrates that the new HUGO RAS system for gynecologic surgery is safe with good results in terms of surgical efficacy and perioperative outcomes. Further studies are needed to investigate its use in other technical and surgical aspects.

Robot-Assisted Pyeloplasty with HUGO™ Robotic System: Initial Experience and Optimal Surgical Set-Up at a Tertiary Referral Robotic Center.

Background: In February 2021 Medtronic® (Minneapolis, MN) launched the HUGO™ Robot-Assisted Surgery (RAS) System in the global market. The aim of the current study is to describe the first case series and the optimal setup of robot-assisted pyeloplasty procedure, performed with HUGO RAS system in a tertiary referral robotic center. Methods: Data from consecutive patients who underwent robot-assisted pyeloplasty at Onze-Lieve-Vrouwziekenhuis Hospital (Aalst, Belgium) were recorded. Baseline characteristics, and perioperative and surgical outcomes were collected. Results: Overall, 10 robot-assisted pyeloplasties were performed (October 2022-September 2023). Based on our expertise, the following minor setting changes have been made, relative to the official setup guide: the endoscope port and, subsequently, the left and right-hand ports were positioned more laterally. Additionally, the reserve/4th port was placed more laterally and cranially, and adjusted the arm cart's tilt angle, reducing it from -30° to -15°. The median docking time was 8 (interquartile range [IQR]: 7.2-9.8) minutes, and the median active console time was 89.5 (80.0-95.8) minutes. No conversion to open/laparoscopic surgery or perioperative complications was encountered. A single technical problem was recorded in 1 (10%) procedure. Specifically, one arm was blocked, and the procedure was accomplished with three arms without compromising the procedure success. Conclusions: This study represents the first worldwide series of robot-assisted pyeloplasty performed with the HUGO RAS system and shows promising results. The procedure might be safely performed with this robotic platform achieving optimal perioperative outcomes.

IDEAL-D Phase 0 Evaluation of the Avatera System in Robot-Assisted Prostate, Bladder and Renal Surgery.

Purpose: To evaluate the utilization of novel Avatera system in urological operations according to the IDEAL-D framework recommendations for high-risk invasive surgical devices. Materials and Methods: Three surgeons attempted to perform 23 upper and lower urinary tract operations on human cadavers and in live porcine models using the Avatera system. Total operative time and the duration of the substeps were evaluated. Surgical performance was assessed with the Global Evaluative Assessment of Robotic Skills (GEARS) score. Suturing was rated using the technical checklist for the assessment of suturing in robotic surgery. Attending surgeons rated their satisfaction with the Avatera system on a scale of 1-5. Results and Limitation: Seventeen out of 18 operations performed on cadavers were completed, while one pyeloplasty was discontinued. All five operations performed in porcine models were completed. Although 1 pig was euthanized on the fifth postoperative day, its symptoms were unrelated to surgery. Mean GEARS and Suturing scores in the upper urinary tract were 29 ± 0.7 and 29.5 ± 0.95, respectively, and in the lower urinary 28.5 ± 1.2 and 29.5 ± 0.5, respectively. Surgeons' satisfaction was high or very high for all procedures. Conclusions: The Avatera system was associated with good surgical performance and high surgeons' satisfaction rates. All urological procedures performed were shown to be feasible, with comparable risks to other robot-assisted surgery systems.

Robot-assisted partial nephrectomy using the novel Hugo™ RAS system: Feasibility, setting and perioperative outcomes of the first off-clamp series.

Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System. Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic's port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration. Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4-8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68-115 min). Median estimated blood loss were 200 ml (IQR, 50-400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days. We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration.

Robot-assisted navigation for percutaneous localization of peripheral pulmonary nodule: an in vivo swine study.

Robot-assisted surgery (RAS) systems have been developed but rarely applied to lung nodule localization. This study aimed to assess the feasibility and safety of using a robot-assisted navigation system in percutaneous lung nodule localization. A computed tomography (CT)-guided robot-assisted navigation system was used to localize the simulated peripheral nodule in the swine lung through fluorescent agent injection. After the localization, fluorescent thoracoscopic wedge resection was performed. The deviation between the target point and the needle tip was measured using a professional 3-dimensional (3D) distance measurement software. The primary outcome was the localization accuracy (deviation) of the localization. The secondary outcomes were the localization-related complication rate, the localization duration, and the success rate. A total of 4 pigs were enrolled, and 20 peripheral lung nodules were created and localized successfully. All nodules underwent subsequent wedge resection for verification. The mean deviation by measuring the 3D distance was 3.81 mm [standard deviation (SD): 1.29 mm, 95% confidence interval (CI): 2.936-4.536 mm]. The technical success rate for localization was 100%, and the mean localization time was 14.69 minutes (SD: 4.67 minutes). The complication rate was 5% (1/20), with 1 pneumothorax after localization, and no mortality occurred. This pilot animal study demonstrated the promising potential of the robot-assisted navigation technique in peripheral lung nodule localization, with high accuracy and feasibility. Further clinical trials are needed to validate its safety compared to traditional manual localization.

First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study.

The Medtronic Hugo™ Robot-assisted Surgery (RAS) system was recently approved for clinical use. We explored the safety and feasibility of this system for endometriosis surgery. The primary outcome was safe case completion without major surgical complications (Clavien-Dindo grade ≤2) and no conversion to open surgery or laparoscopy. Surgeries for endometriosis performed at the Department of Gynecology, Rigshospitalet, on the Medtronic Hugo™ RAS system were included. Two experienced robotic surgeons performed all surgeries with their usual robotic team. The variables included were patient demographics, peri- and postoperative data, complications and 30-day readmission rate. We used the IDEAL framework 1/2a for surgical innovation in this descriptive study. The first 12 patients were included. All cases were completed without intraoperative complications or conversion. Four patients experienced Clavien-Dindo grade 1 postoperative complications. No patients were re-admitted within 30 days. Median docking time (17 minutes), console time (87.5 minutes), blood loss (40 mL) and length of hospital stay (1 day) were acceptable compared with previous literature. In this pilot study, we found the Medtronic Hugo™ RAS system safe and feasible for robot-assisted surgery for endometriosis. The advent of new robotic systems is welcomed to accelerate the development of technology that will advance surgical care for patients across the globe.

A comparative analysis of the HUGOTM robot-assisted surgery system and the Da Vinci® Xi surgical system for robot-assisted sacrocolpopexy for pelvic organ prolapse treatment.

We aimed to compare the outcomes of Robot-assisted sacrocolpopexy (RASC) performed using the novel HUGOTM Robot-Assisted Surgery (RAS) System with the Da Vinci® Xi surgical system. Data from 38 women undergoing RASC for a ≥ 2-grade pelvic organ prolapse were collected (2021-2023). Overall, 23 (60.5%) and 15 (39.5%) procedures were performed using the DaVinci® Xi and the HUGOTM RAS system, respectively. The median total operative time was 123 (IQR:106.5-140.5) minutes for the DaVinci® Xi versus 120 (IQR:120-146) minutes for the HUGOTM RAS cases (p=0.5). No conversion to open/laparoscopic surgery, perioperative complications, or system failures occurred. No differences were recorded according to day of catheter removal and length ofstay. This study represents the first worldwide comparison of RASC executed using the HUGOTM RAS versus the Da Vinci® Xi System. Our data suggest that RASC might be performed with both robotic platforms with similar perioperative outcomes.

PE007 - A comparative analysis of the HUGO™ robot-assisted surgery system and the Da Vinci® Xi surgical system for robot-assisted sacrocolpopexy

PE007 - A comparative analysis of the HUGO™ robot-assisted surgery system and the Da Vinci® Xi surgical system for robot-assisted sacrocolpopexy

Robot-assisted oncologic pelvic surgery with Hugo™ robot-assisted surgery system: A single-center experience

ObjectiveTo report the outcomes of intra- and extra-peritoneal robot-assisted radical prostatectomy (RARP) and robot-assisted radical cystectomy (RARC) with Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA). MethodsData of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported. The primary endpoint of the study was to report the surgical setting of Hugo™ RAS system to perform RARP and RARC. The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes. ResultsSeventeen patients underwent RARP with a transperitoneal approach, and three with an extraperitoneal approach; and one patient underwent RARC with intracorporeal ileal conduit. No intraoperative complications occurred. Median docking and console time were 12 (interquartile range [IQR] 7–16) min and 185 (IQR 177–192) min for transperitoneal RARP, 15 (IQR 12–17) min and 170 (IQR 162–185) min for extraperitoneal RARP. No intraoperative complications occurred. One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment (Clavien-Dindo Grade 2). In case of transperitoneal RARP, two minor complications occurred (one pelvic hematoma and one urinary tract infection; both Clavien-Dindo Grade 2). ConclusionHugo™ RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery. We showed the feasibility of RARP both intra- and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.

Initial Experience of Robot-Assisted Simple Prostatectomy with Hugo Robot-Assisted Surgery System: Step-by-Step Description of Two Different Techniques.

Introduction: There are only a few clinical data on nononcologic procedures performed with the new Hugo™ robot-assisted surgery (RAS) system. Robot-assisted simple prostatectomy (RASP) is a minimally invasive treatment option for benign prostatic hyperplasia, and it demonstrated equal early functional and better perioperative outcomes as compared with open simple prostatectomy. In this article, we reported the first large series of RASP performed with Hugo RAS system. Methods: This Supplementary Video S1 is a step-by-step description of two different techniques for RASP. We analyzed the data of 20 consecutive patients who underwent RASP at OLV Hospital (Belgium) between February 2022 and March 2023. Patients baseline characteristics, perioperative and pathologic, and 1-month postoperative outcomes were reported, using the median (interquartile range [IQR]) and frequencies, as appropriate. Results: Median age (IQR) and preoperative prostate specific antigen (PSA) were 72 (67-76) years, and 7.7 (5.0-13.4) ng/mL, respectively. A total of 11 patients experienced an episode of preoperative acute urinary retention, and 8 men had an indwelling bladder catheter at the time of the surgery. No intraoperative complication occurred, and there was no need for conversion to open surgery. Median operative and console time were 165 (121-180) and 125 (101-148) minutes. On the first postoperative day the urethral catheter was removed in 80% of the patients. Median length of stay was 3 (3-4) days. Three patients had minor postoperative complications. On final pathology report, median prostate volume was 120 (101-154) g. On postoperative uroflowmetry, median Qmax and postvoid residual were 16 (13-26) mL/s and 15 (0-34) mL, respectively. Conclusions: This series represents the first report of surgical outcomes of RASP executed with Hugo RAS system. Awaiting study with longer follow-up, our study suggests that Hugo RAS has multiple applications, and it can ensure optimal outcomes in nononcologic procedures.

Robot-assisted cholecystectomy with the new HUGO™ robotic-assisted system: first worldwide report with system description, docking settings, and video.

Robotic surgery has gained worldwide acceptance in the past decade, and several studies have shown that this technique is safe and feasible. The innovation of this system is the open surgical console with an HD-3D display, a system tower, and four independent arm carts. We describe the first robot-assisted cholecystectomy performed with the new Hugo RAS (robotic-assisted surgery) system (Medtronic, Minneapolis, MN, USA) in Spain. The procedure was completed without conversion. No intraoperative complication or technical failure of the system was recorded. The operative time was 70min. The docking time was 3min. Hospital length of stay was 1days. This case report shows the safety and feasibility of cholecystectomy with the Hugo RAS system and provides relevant data that may be of help to early adopters of this surgical platform.

Nerve-sparing robot-assisted radical prostatectomy with the HUGO™ robot-assisted surgery system using the 'Aalst technique'.

Nerve-sparing robot-assisted radical prostatectomy with the HUGO™ robot-assisted surgery system using the 'Aalst technique'.

Hugo RAS Robot-Assisted Partial Nephrectomy for High-Nephrometry Score Complex Renal Mass: Case Report and Surgical Technique

Hugo™ robot-assisted surgery (RAS) system has been conceived with enhanced modularity cart features and an independent arm-cart docking, nonetheless its role for nephron-sparing surgery has not been defined yet. From October 2022, 15, consecutive patients underwent off-clamp robot-assisted partial nephrectomy (RAPN) for T1 tumors. We are a solely off-clamp partial nephrectomy (PN) center, consequently the T2 RAPN was carried out clampless. Furthermore, we acquired experience and familiarity with Hugo RAS, thanks to an initial series of 15 robotic radical prostatectomies. We report the first RAPN with the new Hugo RAS system for a large highly complex right posterior hilar renal mass (8 cm, cT2) in a 63-year-old man with a BMI of 35.3 kg/m2. The choice to perform RAPN for high-nephrometry score renal mass without hilar clamping was because of the technique we usually perform at our center as we have never done on-clamp procedures. The purpose was to assess the feasibility and the modularity of Hugo RAS independent arm-cart docking even in complex posterior hilar renal tumor, and to explore its role in the setting of off-clamp RAPN. Preoperative hemoglobin, serum creatinine, and estimated glomerular filtration rate were 15.5 g/dL, 0.92 mg/dL, and 115.1 mL/min per 1.73 m2, respectively. The patient was placed on an extended flank position. A modified three-arm configuration was used by a conventional transperitoneal route. Port placement and docking time required 5 minutes. Complete kidney mobilization, identification of arterial branches feeding the tumor, and straightforward approach to the renal mass represented standard key steps of our off-clamp RAPN technique. Tumor enucleation was achieved developing an anatomical cleavage plane. Intraoperative bleeding was controlled with double suction, a slight increase of the pneumoperitoneum to 20 mm Hg, monopolar energy, and renorraphy with a 2/0 Monocryl single-running suture using a sliding-clip technique. No intraoperative complications occurred. No additional port placement was necessary. Console time was 110 minutes, estimated blood loss were ~500 mL. Patient was discharged on postoperative day 3 after bladder catheter and abdominal drain removal, with hemoglobin, serum creatinine, and eGFR of 11.8 g/dL (∆Hb 3.7 g/dL), 0.94 mg/dL, and 112.6 mL/min per 1.73 m2, respectively. Histologic evaluation revealed a chromophobe renal cell carcinoma. Considering the intra- and perioperative outcomes, the lack of complications, and the fast docking, this robotic platform seems to be an user-friendly technology. Currently, the small series considered as the granularity of data regarding the application of Hugo RAS in the RAPN setting hinder to assess that this novel platform is comparable with conventional robotic systems. Further studies with a larger cohort are needed to establish the noninferiority of this platform, but preliminary results seem encouraging. The authors declare no conflict of interest and any commercial associations during the past 3 years. No funding was received for this article. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Institutional Review Board Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Source of Work: This study was carried out at Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy. Runtime of video: 4 mins 45 secs

Concomitant Introduction of New Robotic Systems (Hugo RAS and Versius) at a Single Center: Analysis of First Clinical Cases of Radical Prostatectomy by a Single Surgeon

Abstract Introduction: Radical prostatectomy is a standard option for clinically localized prostate cancer. The first robot-assisted radical prostatectomy (RARP) was performed in 2001 with the DaVinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA); after 2 decades from the first procedure and the expiry of the patents, new systems are entering the market to improve the existing technology and increase the whole accessibility to robotic surgery. Currently, a face-to-face comparison of systems is still unavailable. The aim of the study was to report the first case of concomitant introduction of new systems—Hugo robot-assisted surgery (RAS) and Versius surgical system—at a single center already equipped with a Da Vinci. Methods: This is a prospective study that analyzes the first cases performed with the Hugo RAS and Cambridge Medical Robotics Versius for RARP at a single center. Three patients with clinical organ-confined prostate cancer were selected to receive a Hugo RAS, a CMR Versius, or a DaVinci—as standard reference—radical prostatectomy. All procedures were recorded, and videos were reviewed by internal and external reviewers. RARP was evaluated according to the definition of metric errors and critical errors (Mottrie et al, BJU 2020) (See Supplemental Data, http://links.lww.com/JU9/A20). The primary end point is to evaluate the safety of novel systems; outcome measure is the absence of critical errors or intraoperative adverse events. Results: Surgical procedures were fully completed with all robotic systems. No intraoperative adverse events occurred, nor surgical errors classified as “critical” according to the European Association of Urology Robotic Urology Section metric system. None of the metric error nor technological issues were clinically significant to invoke a change in surgical strategy. Conclusions: This is the first analysis of concomitant introduction of new robotic systems at a single institution. Even if the shift from one model to another is expected to pose some challenges for surgeons, RARP is feasible with HugoRAS and Versius systems by an already experienced surgeon with the Da Vinci. A proper structured training is mandatory; the impact of prior console expertise is unknown and still unmeasured, but is expected to have significance. The current clinical experience supports the feasibility of the implementation of a new surgical system into surgical practice; however, further studies are required to evaluate outcomes in an unselected cohort.

Day surgery unit robotics thoracic surgery: feasibility and management.

Day surgery has been widely carried out in medical developed countries such as Europe and the United States with high efficiency, safety and economy. The development of thoracic day surgery started late, and currently only a few top three hospitals carry thoracic day surgery. In recent years, with the continuous in-depth application of the concept of accelerated rehabilitation surgery (ERAS) in the field of surgery, thoracic surgery ERAS has also entered clinical practice with remarkable results. At present, the application of day surgery in the field of thoracic surgery is still in its infancy, and the application of robot-assisted thoracic surgery in thoracic surgery has brought new opportunities for the popularization of day surgery in thoracic surgery. We retrospectively reviewed 86 patients underwent thoracic day surgery under the application of robot-assisted surgery system and through systematic randomization method choose 86 patients underwent conventional thoracic surgery under the application of robot-assisted surgery system at our Institute between 2020 and 2022. We analyzed the clinical and pathological features between the two groups. The clinical feature of location of the nodules, the size of nodules, pN, histology and postoperative complications were homogenous between the two groups. The average age was significantly higher in the conventional mode group, the ratio of male patients and the patients with history of smoking were significantly lower in day-surgery mode group. The major surgical method in conventional mode group was lobectomy resection (48.8%). While the segmental resection was the major surgical in day surgery mode group. The hospital stay and the time of drain was significant longer in conventional mode group. And the total medical cost in conventional was more than day-surgery mode group. While the histology and postoperative complications were homogenous between the two groups. Before this, day surgery and robotics assistant surgery in thoracic surgery had been proved feasibility and safety. However, there was no report of day surgery unit robotics assistant thoracic surgery. Our clinical practice demonstrated that the method of day surgery unit robotics thoracic surgery is feasibility and safety enough.