Dietmar Stephan, MD, Ibrahim Darwich, MD, Badrig Melekian, MD, Frank Willeke, MD. St. Marien-Krankenhaus Siegen
The robot-assisted surgery was previously associated with the name DaVinci® (Intuitive) worldwide. Since 2016, a second robotic system has been available with the Senhance® (Transenterix). The system is based on laparoscopy and is characterized in particular by haptic feedback, scope control by eye tracking and reusable instruments.
In laparoscopic surgery, the use of an advanced energy device has long been a daily routine and is used especially for safe vascular closure during preparation.
Therefore, the application of an advanced energy device in robotic surgery is similarly a critical tool. Senhance has recently introduced the Senhance Ultrasonic System, an advanced energy device, which is now approved for clinical use (CE Mark since October 2018 and FDA approval since January 2019).
We will report on the unique characteristics of the technology and the first experience of using the Ultrasonic system in various operations since November 2018. All cases using Senhance Robotic System are documented in the Transenterix European Registry Study TRUST.
The Senhance Ultrasonic system consists of a reusable shaft and a disposable part, which are connected together with the robotic adapter and thereby to the robot arm. Used application mode and frequencies of oscillation are different to other devices. The application of ultrasound between the branches of the instruments takes the form of torsional movements between the branches. This leads to a lower ambient temperature, especially in the area of the tip. The Senhance Ultrasonic system uses 36 KHz. There are various stages of energy delivery available (cutting mode -high/coagulation mode – low /slow coagulation mode – ultra low). The various modes (cutting mode/coagulation mode) can be selected via a footswitch. Likewise, the activation is done via a footswitch.
In all operations, the Senhance Ultrasonic system (5 mm in diameter) was inserted through a 5 or 10 mm trocar, connected to the robotic arm and used for tissue dissection and secure closure of vessels. Only occasionally additional monopolar or bipolar energy was applied via other instruments (bipolar grasper / monopolar scissors).
We performed 10 cases with the Senhance Ultrasonic System in various operations. In particular, these were operations in the field of general surgery, gynecology and coloproctology (Inguinal Hernia Repair 4, Nissen Fundoplication 2, Cholecystectomy 1, Total Laparoscopic hysterectomy 1, Bilateral Ovariectomy 1, Sigmoid resection 1). In no case, we observe uncontrolled bleeding. Both in dissection and in vessel closure, safe hemostasis could be achieved. No rebleeding was observed. Also, larger vessels, such as the Gastric vessels in the area of the fundus could be safely closed. In no case did damage of surrounding tissues occur. In the first 10 cases were no unscheduled conversion to laparoscopic or open surgery.
The first results with the Senhance Ultrasonic System show that it can be safely used in various abdominal procedures. The initial results suggest that the Senhance Ultrasonic System will be a critical tool in further robotic surgery, ensuring safe vessel occlusion with low risk of injury to surrounding tissue.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98870
Program Number: ETP740
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster