Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection

Summary

Robotically assisted surgery has become highly popular in recent years. Presented here is the standard care for upper gastrointestinal procedures, including a demonstration of a robotic-assisted gastric wedge resection using a modular robotic device.

Abstract

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was approved for in-human use in Europe. Possible applications for this new robotic system are being explored, and standardized approaches are evolving. In lieu of this, a gastric wedge resection and the standardized setup for upper gastrointestinal procedures using this new system are presented here. This safe and feasible robotic procedure is demonstrated in a 69-year-old patient with a gastric tumor. All steps of the surgery are described in a detailed and reproducible manner. The article also details trocar positioning, arm adjustments, and required surgical instruments. Docking time amounted to 13 min, whereas the console time took 115 min. The patient was discharged after 4 days after ensuring an uneventful course. The presented method is also suitable for other surgical purposes, such as fundoplications or hiatoplasties, and ensures both generalizability and reproducibility.

Introduction

Robot-assisted surgery (RAS) is an advanced minimally invasive technique, which is associated with potential advantages such as fastened recovery times, shortened hospitalization and reduced risk of complications. According to Goh et al.¹, surgeons benefit from better visualization, ergonomics, and dexterity.

Recently, a much-awaited modular robotic device was approved for in-human use in Europe in the field of visceral surgery². Extensive experience has already been gathered by urologists earlier on^3,4,5

Protocol

All steps presented in the surgical method follow the guidelines of the ethics committee of the Ruhr-University Bochum, Germany. The study was approved by the local ethics committee (No.23-7872-BR). Informed consent was obtained from the patient for the presentation of the data and video material.

1. Patient positioning and surgical setting

1. Patient positioning
   1. Situate the patient in supine position, anti-Trendelenburg 30° and slightly rolled to the right (10-15°).
   2. Do not split the legs and position the abdomen at a height of >70 cm above ground by adjusting the operating tabl....

Results

Docking time amounted to 13 min, whereas console time took 115 min. The tumor was removed, and the wounds were closed after another 15 min. There were no intraoperative complications or robotic malfunctions and hardly any blood loss. The patient was monitored in the recovery room for 3 hours postoperatively. The further course in the hospital was uneventful. There was no sign of postoperative bleeding or insufficiency of the stapling line. Therefore, the drain was removed after 2 days. There were 3 blood tests screening .......

Discussion

The method is tailored for upper gastrointestinal purposes. Low regions of the abdominal cavity are not able to be reached and require different trocar and arm cart positions. A critical step is the placement of the trocars, which are supposed to be placed at a sufficient distance of at least 9 cm from each other. Otherwise, conflicting movements of the robotic arms may occur. Nevertheless, trocars must not be placed too close to osseous structures. Conflicts of the arms can sometimes be circumvented by slight alteration.......

Materials

Name	Company	Catalog Number	Comments
Easy Flo	P.J. Dahlhausen, Köln, Germany		12 mm
Endo GIA Ultra	Medtronic, Dublin, Ireland
EndoRetrieval Pouch	Mölnlycke Health Care GmbH, Düsseldorf, Germany
Ethilon	Ethicon, Bridgewater, New Jersey, USA		3-0
Hugo RAS	Medtronic, Dublin, Ireland
Ligasure	Medtronic, Dublin, Ireland		44 cm, Blunt tip, laparoscopic version
Stomach Probe	Medicoplast, Illingen, Germany		Probe with plastic guidewire
UHI CO2 Insufflation Unit	Olympus, Hamburg Germany
Vicryl Sutures	Ethicon, Bridgewater, New Jersey, USA	1 and 3-0