E Wilson1, A Jah2, J Morton2. 1Memorial Hermann / UT Health, 2Cambridge University Hospitals
Objective: To discuss the feasibility of the Versius® robotic surgical system for use in the minimal access approach to cholecystectomy
Description of the technology:
The Versius® robotic surgical system is a newly developed system designed to carry out a range of minimal access procedures.
It employs an open console design with independent modular arms. The arms are multi-jointed and have a unique four-axis wrist allowing 270 degrees of rotation of the distal arm. A range of 5mm fully-articulated instruments can be mounted on the arms. Each arm is mounted on an independent mobile plinth allowing freedom of positioning alongside the operating table.
Preliminary results
The Versius® system is currently undergoing phase 0 development of the IDEAL collaborative process[i]. It has been employed in more than 200 cadaveric cases across a range of abdominal and thoracic surgical procedures. A total of 23 cadaveric cholecystectomies have been performed – port positions are demonstrated in Fig 2 – and four survival porcine cholecystectomies were completed with all the candidates making a completely successful recovery, thus demonstrating the functionality and safety of the instrumentation and electrosurgical system.
During the live studies the team was able to drape the system and patient and insert the ports and instruments in 20 minutes, a time comparable with set up time in routine laparoscopic cholecystectomy.
Conclusions/Future Directions
Cholecystectomy is one of the most commonly performed operations in the United States. However, despite this, the serious complication rates associated with this procedure are higher than with the corresponding open procedure[ii]. It is possible that the precision available with a robotically assisted MAS procedure may overcome this. Criticism of the current robotic approach is that it is more time consuming and employs the use of larger instrumentation.
This experimental work has demonstrated the ability of the Versius® system to successfully carry out a minimal access cholecystectomy in cadavers over a large range of BMI’s. The animal work has demonstrated the safety of the system in these operations.
The Versius® system allows port placement with the same configuration as the routine laparoscopic approach. In addition, it allows utilization of a 5mm Applied® port thus mimicking a standard approach. The use of a robotic system facilitates a more ergonomic posture thus preventing discomfort and injury. The studies suggest that it can be achieved in the same time as a routine laparoscopic cholecystectomy.
Human studies must be conducted to confirm the applicability of this technology for cholecystectomy. These studies will also support the extension of its use to other surgical procedures.
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[i] McCullough P, Altman D, Campbell W, Flum D, Glaziou P, Marshall J et al No surgical surgical innovation without evaluation: the IDEAL recommendations. Lancet 2009;374; 1105-1112
[ii] Khan MH, Howard TJ, Fogel EL, Sherman S, McHenry L, Watkins JL, Canal DF, Lehman GA Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc. 2007;65(2):247.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98900
Program Number: ET006
Presentation Session: Emerging Technology Session
Presentation Type: Podium