Ravi Aggarwal, MRCS, Jasmine Winter-Beatty, MRCS, James Kinross, PhD, FRCS, Alexander C Von Roon, PhD, FRCS, Ara W Darzi, MD, FRCS, FACS, Sanjay Purkayastha, MD, FRCS. Department of Surgery & Cancer, Imperial College London
Introduction: The TransEnterix Senhance™ Surgical Robotic System is a novel system that has recently received FDA clearance. With this clearance, the Senhance™ became the first new market entrant into the field of abdominal surgical robotics since 2000. It aims to provide the robotic benefits of greater accuracy, dexterity and control with similar operational costs to traditional laparoscopy. We evaluated the feasibility, safety and learning curve of this novel system on performing cholecystectomy.
Methods: The device is a multi-port system with independent robotic arms that replicate familiar laparoscopic instrument motion. These arms are controlled from a console where the primary surgeon sits.
The console provides the surgeon with 3D-HD vision on the screen, as well as an infrared eye-tracking system that enables the surgeon to control the movement of the laparoscopic camera by focusing their gaze on different areas of the monitor. The surgeon receives haptic force feedback through the ergonomic handles in the console. The system utilizes reusable instruments that are similar to standard 5mm laparoscopic instruments with very minimal disposables.
A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance™ system was reviewed. All operations were performed by a single surgeon and the same team at a hospital in London, UK. Data including operative time, console time, set up time, and adverse events were collected.
Results: Nineteen of the twenty procedures (95%) were completed robotically. The other case was converted to standard laparoscopy. No cases were converted to open. 95% of patients were discharged on the day of surgery. Post-operatively only one patient had a surgical complication, namely a wound infection treated with antibiotics only.
The mean +/- SD operating time was 86 +/- 24 minutes. The mean setup time (the docking of the robotic arms) was 11.8 +/- 3.3 mins and the mean console time for the robotic group was 30.8 +/- 8.7 minutes. Both the docking time and console time seemed to improve over time however this change was not significant. The docking time decreased from 13.0 +/- 4.1 mins (first 10 cases) to 10.6 +/- 1.9 mins (cases 11-20, p=0.14) and the console time decreased from 32.8 +/- 10.5 mins (first 10 cases) to 28.7 +/- 8.7 mins (cases 11-20, p=0.52)
Conclusions: Our results suggest that Senhance™ assisted cholecystectomy is safe, feasible and effective. The system offers significant advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking and usability of standard laparoscopic trocars and reusable instruments.
The operative time data does not show a significant learning “curve”, albeit only after 20 cases. A learning curve may become apparent with increased use of the system. Also, currently the total operative times are significantly higher than standard laparoscopy.
Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91244
Program Number: ET011
Presentation Session: Emerging Technology Session (Non CME)
Presentation Type: Podium