Robotic right colectomy using the new Senhance® robotic platform: a three-trocar technique - a video vignette

Experiences in robotic colorectal surgery: comprehensive insights from a multi-center analysis using the Senhance Robotic System

Robotic-assisted surgery has revolutionised minimally invasive approaches, particularly in colorectal surgery. While many single-center studies on colorectal surgeries exist in present literature, including experiences with Senhance® Robotic Systems, comprehensive multi-center studies are lacking. This study, conducted through the TransEnterix European Patient Registry ("TRUST"), aims to assess the safety and feasibility in this context. The present study explored procedural times, complications, robotic malfunction and limitations, adverse events and pain management outcomes for colorectal procedures, including sigmoid resection, right hemicolectomy and rectal surgery collected in two European centers. Data from 355 colorectal surgeries showed that the median duration of surgery was 147.2 min (IQR: 124.3-183.0), the docking time was reported with a median of 3.4 min (IQR: 2.0-5.4) and the console time was found at a mean of 84.4 min (SD: 33.6). Despite minimal blood loss, pain scores, and robotic malfunction, 2.9% of the cases (10 instances) required conversions to either an open or laparoscopic approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Adverse events (24 cases, 6.8%) were effectively managed, with 23 instances judged completely unrelated to the robotic system. This study underscores the positive outcomes and safety profile of Senhance® Robotic Systems in colorectal surgery, contributing valuable insights for future research and clinical practice.

New Robotic Platforms in General Surgery: What's the Current Clinical Scenario?

Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills' transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.

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.

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.

Short-term results of robot-assisted colorectal cancer surgery using Senhance Digital Laparoscopy System

BACKGROUND

The Senhance Digital Laparoscopy System (Asensus Surgical Inc, Morrisville, NC, United States), which was introduced for the first time in Japan by our hospital, is a new surgical assistive robot following the da Vinci Surgical System. We herein report the short-term outcomes of 55 colorectal cancer surgery cases using this system at our hospital to assess the feasibility and safety of our procedures.

MATERIALS AND METHODS

We retrospectively reviewed the patient backgrounds and surgical outcomes of 55 patients who underwent Senhance-assisted laparoscopic colorectal cancer surgery.

RESULTS

The median age was 71 years. There were 31 males and 24 females, and the median body mass index was 23.1 kg/m² . Fifteen patients had a history of abdominal surgery. The most common surgical technique was ileocecal resection (18 cases, 32.7%), followed by high anterior resection (11 cases, 20.0%). D2 or D3 dissection was performed in each operation, and D3 dissection was performed in 41 cases (74.5%). The median operative time was 240 minutes, the median blood loss was 5 mL, there were no intraoperative complications, and there were no cases of intraoperative blood transfusion. The median postoperative hospital stay was 7 days, which was comparable to conventional laparoscopic surgery. Postoperative complications of grade 2 or higher in the Clavien-Dindo classification were observed in two cases.

CONCLUSION

The short-term results of 55 colorectal cancer surgery cases using the Senhance Digital Laparoscopy System were excellent and the system was introduced and surgery was safely performed.

Robotic colorectal surgery using the Senhance® robotic system: a single center experience

BACKGROUND

The aim of this study was to evaluate the initial experience of a single robotic center with the Senhance^® robotic systems (TransEnterix Surgical Inc, Morrisville, NC, USA) in colorectal surgery.

METHODS

We performed a retrospective analysis of prospectively collected data of patients who underwent colorectal surgery using the Senhance^® robotic systems, from November 2018 to November 2020. Perioperative, intraoperative, and short-term postoperative data were assessed.

RESULTS

There were 57 patients (28 women and 29 men, mean age 61.7 ± 6.2 years [range 23-84 years]). Forty-eight (84.2%) patients underwent surgery for colorectal cancer (22 colon cancer and 26 rectal cancer) and 9 (15.8%) for benign conditions. Mean operating time was 194 min ± 57.8 min (range 90-380 min). In total, 27(47.4%) operations were performed on the colon and 30 (52.6%) on the rectum; mean length of postoperative hospital stay was 8 ± 6.2 days (range 3-48 days). There were 2 (3.4%) conversions to open surgery. No intraoperative complications occurred. Seven patients (12.3%) had postoperative complications 3 (5.3%) of whom had to be treated under general anesthesia. There was no mortality. In 48 patients operated on for colorectal cancer, the mean lymph-node harvest was 18 ± 7.9 (range 7-38 lymph nodes). In the rectal cancer group of 26 patients, the distal resection margin was 3.3 ± 1.8 cm.

CONCLUSIONS

In our experience, surgery using the new Senhance^® robotic system was safe and feasible in surgery of the colon and rectum. Randomized controlled trials comparing this type of colorectal surgery with laparoscopic and/or other types of robotic surgery are needed.

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.

An early experience with the Senhance surgical robotic system in colorectal surgery: a single-institute study

BACKGROUND

We present our initial single-centre experience with Senhance surgical robot-assisted colorectal surgery and examine its safety and feasibility.

METHODS

From June 2019 to December 2019, patients who underwent Senhance surgical robot-assisted colorectal surgery in our hospital were retrospectively analysed. We focused on the short-term outcomes.

RESULTS

In total, 46 patients were enrolled in the study. Colorectal cancer was the most common indication for surgery (39 patients). The median total operation time was 283 min, and the median blood loss was 50 cc. Meanwhile, the median number of harvested lymph nodes was 20. Elderly age, advanced American Society of Anaesthesiologists stage, and right-sided colon surgery were associated with the occurrence of complications greater than grade III.

CONCLUSION

Our findings demonstrate the feasibility and safety of the Senhance surgical robotic system in colorectal surgery. Care should be taken regarding the indications and patient selection.

Right hemicolectomy with D3 lymph node dissection for right-sided transverse colon cancer using the Senhance robotic system: a case report

Background

The evolution of remote systems and artificial intelligence technology has led to increase in robotic surgeries. One system used in this case report is the Senhance robotic system. The most important premise for using robotic surgery in cancer therapeutics is to ensure oncological safety. Similar to conventional laparoscopic surgery, robotic surgery needs to be a reliable and secure surgical procedure, such as complete mesocolic excisions with central vascular ligations in Western countries or D3 lymph node dissections (dissection of the lymph nodes that locates from the origin to the terminal branch of the main feeding artery of cancer) in Japan.

Case presentation

A 76-year-old man underwent clinical examination for severe anemia. He was diagnosed with transverse colon cancer of tumor (T)3, node (N)1a, metastasis (M)0 cancer stage IIIA. A right hemicolectomy with D3 lymph node dissection using the Senhance surgical system was performed. The operative time was 313 min and the estimated blood loss was 5 ml. He was discharged from our hospital 12 days after the surgery without any complications. What is the remarkable of this report, not only mobilization of right colon but also D3 lymph node dissection and vascular ligation were performed intraperitoneally by using Senhance robotic system as conventional laparoscopic surgery. We tried using fourth robotic arm to accomplish lymphadenectomies and middle colic artery dissection. A right hemicolectomy with D3 dissection using the Da Vinci surgical system was reported. Another report of a right hemicolectomy performed with the Senhance robotic system was identified; however, in that study, lymph node dissections were not performed intraperitoneally.

Conclusions

Therefore, to our knowledge, this is the first report using the Senhance robotic system for right hemicolectomy with D3 dissection. We hope that our case report will assist in the establishment of this robotic procedure in surgical practice.

A first case of ileocecal resection using a Senhance Surgical System in Japan

BACKGROUND

Several manufacturers are in the process of developing various innovative systems and expect more options in the robot market. One of the latest systems, the Senhance® platform (TransEnterix Surgical Inc, Morrisville, NC, USA), has already been introduced in Europe and has also been approved for clinical use in Japan. We report the first case of colorectal resection using Senhance in Japan.

CASE PRESENTATION

The patient was a 79-year-old Japanese man who visited a previous physician for positive fecal occult blood. Upon close inspection, the preoperative diagnosis was cT2N0M0 stage I. We performed surgery using Senhance. The operation time was 198 min, and the estimated amount of bleeding was 10 g. He was discharged after surgery without any major complications. However, it is also true that the operability of the conventional port arrangement was poor during the surgical operation.

CONCLUSION

We report the first Senhance-assisted ileocecal resection for colorectal cancer in Japan. In the future, we would like to find more ways to use it by accumulating more cases.

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.