Next Article in Journal
Obesity, Bariatric Surgery and Obstructive Sleep Apnea—A Narrative Literature Review
Previous Article in Journal
Pregnancy-Associated Spontaneous Coronary Acute Dissection as a Cause of Sudden Cardiac Death—Autopsy Findings and Literature Review: Is COVID-19 Related?
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Medicina
Volume 59
Issue 7
10.3390/medicina59071264
medicina-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

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

by
Francesco Marchegiani
1,
Leandro Siragusa
2,
Alizée Zadoroznyj
1,
Vito Laterza
1,
Orsalia Mangana
1,
Carlo Alberto Schena
1,
Michele Ammendola
3,
Riccardo Memeo
4,
Paolo Pietro Bianchi
5,
Giuseppe Spinoglio
6,
Paschalis Gavriilidis
7 and
Nicola de’Angelis
1,*
1
Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
2
Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
3
Science of Health Department, Digestive Surgery Unit, University “Magna Graecia” Medical School, 88100 Catanzaro, Italy
4
Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital “F. Miulli”, 70021 Acquaviva delle Fonti, Italy
5
Division of General and Robotic Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy
6
Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
7
Department of Surgery, Saint Helena General Hospital, Jamestown, Saint Helena STHL 1ZZ, South Atlantic Ocean, UK
*
Author to whom correspondence should be addressed.
Medicina 2023, 59(7), 1264; https://doi.org/10.3390/medicina59071264
Submission received: 13 June 2023 / Revised: 1 July 2023 / Accepted: 4 July 2023 / Published: 7 July 2023
(This article belongs to the Section Surgery)
Browse Figure
Versions Notes

Abstract

:
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.

1. Introduction

Twenty-two years after the clinical introduction of the first Intuitive Surgical Da Vinci system, only a limited percentage of general surgery procedures are performed via robotic approach in Western countries [1]. In addition, there is a great disparity between developed and low-income countries where robotic surgery remains unsustainable despite its potential technical advantages [1,2].
Historically, AESOP® and ZEUS, both produced by the American Computer Motion, were the first robotic surgical systems adopted in general surgery [3]. In 2003, after long legal action, American Computer Motion merged with its main competitor, Intuitive Surgical, which had been founded eight years prior [3]. The company developed several generations of master-slave multi-arm robots protecting their products thanks to the registration of more than 7000 patents which was the main barrier for the development of contenders [4,5]. After twenty years, the first registered patents are progressively expiring allowing the development of competing products [6]. The twenty years monopoly constituted an enormous advantage for the Intuitive Surgical company, whose products were adopted by most surgical specialties, thanks to the claimed technical advantages over laparoscopy provided by 3D imaging, magnification, dexterity, tremor filtration, motion scaling and a quick learning curve [5]. At the beginning of 2023, more than 11 millions robotic surgeries have been performed worldwide with Intuitive Surgical Da Vinci robots, with over 7500 platforms installed worldwide [7].
Nevertheless, the scenario is changing because new robotic platforms have been recently introduced into the market with several new architectures (e.g., modular platforms). Their use appeared to be feasible, but the associated surgical results and clinical effectiveness still require further investigation [8].
The aim of this systematic review was to evaluate the adoption of these new surgical robotic systems in general surgery in terms of clinical data, technical aspects, costs, and learning curve.

2. Materials and Methods

2.1. Search Strategy and Data Sources

The systematic review was performed according to the Cochrane Collaboration-specific protocol [9] and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [10].
A first search was performed in grey literature and on the internet to identify the newly available robotic platforms, different from the Intuitive Surgical Da Vinci S®/Si®/** in the existing publications.
According to the PICOS format, the following items were used to select the retrieved articles:
  • P, population: patients > 18 years undergoing a robotic intervention with a platform different from Intuitive Surgical multiport Da Vinci S®/Si®/** their products in collaboration with clinicians, trying to differentiate their approach and to collect data from the clinical activities. Two recently published registry analyses concerning the adoption of the two mainly diffused new generation robots, namely Asensus Senhance® and CMR Versius®, reported 871 and 2083 cases, respectively [94,124]. The published databases will make the comparison of clinical outcomes simpler and more transparent. Furthermore, the registry promotion distinguished the competitors from Da Vinci.
    The next stage of development will focus on the producer partnership to improve and ameliorate the existing products in order to better compete in a market still dominated by a single leader. The vision capabilities will be augmented thanks to the new technological standards, as announced in February 2023 by Asensus with its new Luna Surgical System endowed with a 4K-3D vision without the need to wear glasses.
    In terms of clinical data analysis, the next major advancement will entail the adoption of artificial intelligence as proposed by Asensus or Medicaroid, in order to digitalize the surgical practice, opening the door to new opportunities such as the telesurgery [149,150].
    The present review presents some limitations mainly related to the low-quality of existing evidence, the design and the small sample of studies included, and the absence of data on several robotic platforms. Nevertheless, this systematic review provides a good snapshot of the real clinical application of the recently introduced platforms in general surgery.

5. Conclusions

Robotic procedures with new robotic devices have been progressively described in hepatobiliary, colorectal, abdominal wall, upper gastrointestinal, endocrine and breast surgery. Despite the low-quality of the current evidence, this review suggests that most surgical interventions are feasible with no technical issues. More platforms are obtaining clinical approvals and their continuous development will be likely stimulated by the Asian market. However, the absence of an international training curriculum and credentialing program hinders the ability to evaluate surgical proficiency and the transferability of skills across different devices. Thus, the future holds substantial technological innovation whose clinical evidence is yet to be established.

Supplementary Materials

The following supporting information can be downloaded at: https://mdpi.longhoe.net/article/10.3390/medicina59071264/s1, Table S1: Mixed series; Table S2: Hepatopancreatobiliary surgery; Table S3: Colorectal surgery; Table S4: Abdominal wall surgery; Table S5: Endocrine surgery; Table S6: Upper gastrointestinal and bariatric surgery; Table S7: Breast surgery.

Author Contributions

Conceptualization, F.M. and N.d.; methodology, F.M., L.S. and C.A.S.; data curation, F.M., L.S., A.Z., V.L., O.M. and C.A.S.; investigation, F.M., L.S., A.Z., V.L., O.M., C.A.S., M.A., R.M., P.P.B., G.S., P.G. and N.d.; writing—original draft preparation, F.M., L.S., A.Z., V.L., O.M. and C.A.S.; writing—review and editing, M.A., R.M., P.P.B., G.S., P.G. and N.d.; visualization, F.M., L.S., A.Z., V.L., O.M., C.A.S., M.A., R.M., P.P.B., G.S., P.G. and N.d.; supervision, R.M. and N.d. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Sheetz, K.H.; Claflin, J.; Dimick, J.B. Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw. Open 2020, 3, e1918911. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Mehta, A.; Cheng Ng, J.; Andrew Awuah, W.; Huang, H.; Kalmanovich, J.; Agrawal, A.; Abdul-Rahman, T.; Hasan, M.M.; Sikora, V.; Isik, A. Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future. Ann. Med. Surg. 2022, 84, 104803. [Google Scholar] [CrossRef] [PubMed]
  3. Pugin, F.; Bucher, P.; Morel, P. History of robotic surgery: From AESOP® and ZEUS® to da Vinci®. J. Visc. Surg. 2011, 148, e3–e8. [Google Scholar] [CrossRef] [PubMed]
  4. World Intellectual Property Organization (WIPO). Global Forum for Intellectual Property Policy, Services, Information and Cooperation. Available online: https://patentscope.wipo.int (accessed on 23 May 2023).
  5. Brodie, A.; Vasdev, N. The future of robotic surgery. Ann. R. Coll. Surg. Engl. 2018, 100, 4–13. [Google Scholar] [CrossRef]
  6. Hughes, T.; Rai, B.; Madaan, S.; Chedgy, E.; Somani, B. The Availability, Cost, Limitations, Learning Curve and Future of Robotic Systems in Urology and Prostate Cancer Surgery. J. Clin. Med. 2023, 12, 2268. [Google Scholar] [CrossRef]
  7. Intuitive Surgical. J.P. Morgan Healthcare Conference 2023. Available online: https://isrg.intuitive.com/static-files/6683d2bb-75e2-4fa0-b0cd-463ead7c30a4 (accessed on 23 May 2023).
  8. Zhang, W.; Li, H.; Cui, L.; Li, H.; Zhang, X.; Fang, S.; Zhang, Q. Research progress and development trend of surgical robot and surgical instrument arm. Int. J. Med. Robot. 2021, 17, e2309. [Google Scholar] [CrossRef]
  9. Higgins, J.P.T.; Thomas, J.; Chandler, J.; Cumpston, M.; Li, T.; Page, M.J.; Welch, V.A. (Eds.) Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (Updated February 2022); Cochrane: London, UK, 2022. [Google Scholar]
  10. Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G.; Group, P. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 2009, 339, b2535. [Google Scholar] [CrossRef] [Green Version]
  11. Kim, C.H.; Al-Sawat, A.; Lee, C.S. Single-port robot-assisted extended totally extraperitoneal repair for ventral hernia using the da Vinci single-port platform: A video vignette. Asian J. Surg. 2022, 45, 1751–1752. [Google Scholar] [CrossRef]
  12. Kim, D.; Lee, C.S. Single-port robotic totally extraperitoneal(TEP) inguinal hernia repair using the da Vinci SP platform: A video vignette. Asian J. Surg. 2022, 45, 2062–2063. [Google Scholar] [CrossRef]
  13. Cruz, C.J.; Yang, H.Y.; Kang, I.; Kang, C.M.; Lee, W.J. Technical feasibility of da Vinci SP single-port robotic cholecystectomy: A case report. Ann. Surg. Treat. Res. 2019, 97, 217–221. [Google Scholar] [CrossRef] [Green Version]
  14. Alshalawi, W.; Lee, C.S.; Lee, Y.S. Single-port robotic intersphincteric resection for very low rectal cancer with the da Vinci SP platform. Asian J. Surg. 2022, 46, 1056–1057. [Google Scholar] [CrossRef] [PubMed]
  15. Bak, M.R.; Lee, I.K.; Lee, Y.S.; Lee, C.S. Single-port robotic ventral mesh rectopexy for recurrent rectal prolapse with the da Vinci SP platform: A video vignette. Asian J. Surg. 2022, 46, 1317–1318. [Google Scholar] [CrossRef] [PubMed]
  16. Minagawa, Y.; Hirano, Y.; Kataoka, A.; Shimamura, S.; Kataoka, M.; Asari, M.; Fujii, T.; Ishikawa, S.; Ishii, T.; Sato, H.; et al. The first single-incision plus one-port transverse colon resection using Senhance Digital Laparoscopy System: A case report. Surg. Case Rep. 2021, 7, 89. [Google Scholar] [CrossRef] [PubMed]
  17. Samalavicius, N.E.; Klimasauskiene, V.; Janusonis, V.; Samalavicius, A.; Dulskas, A. Robotic total mesorectal excision for mid-rectal cancer using the Senhance® robotic platform—A video vignette. Color. Dis. 2020, 22, 592–593. [Google Scholar] [CrossRef]
  18. Hirano, Y.; Kondo, H.; Miyawaki, Y.; Sugita, H.; Sakuramoto, S.; Yamaguchi, S. Single-incision plus two-port robotic surgery for sigmoid colon cancer using the Senhance robotic system. Asian J. Endosc. Surg. 2021, 14, 94–96. [Google Scholar] [CrossRef] [PubMed]
  19. Samalavicius, N.E.; Smolskas, E.; Deduchovas, O.; Janusonis, V.; Dulskas, A. Robotic abdominoperineal resection for pT2N0M0 low rectal cancer using the Senhance TransEnterix robotic platform—A video vignette. Color. Dis. 2019, 21, 847–848. [Google Scholar] [CrossRef]
  20. Samalavicius, N.E.; Smolskas, E.; Deduchovas, O.; Janusonis, V.; Dulskas, A. Robotic right colectomy using the new Senhance® robotic platform: A three-trocar technique—A video vignette. Color. Dis. 2019, 21, 1092–1093. [Google Scholar] [CrossRef]
  21. Samalavicius, N.E.; Smolskas, E.; Janusonis, V.; Deduchovas, O.; Dulskas, A. Robotic sigmoid resection for locally advanced cancer using the Senhance Transenterix robotic platform—A video vignette. Color. Dis. 2019, 21, 1216. [Google Scholar] [CrossRef]
  22. Samalavicius, N.E.; Janusonis, V.; Smolskas, E.; Dulskas, A. Transanal and robotic total mesorectal excision (robotic-assisted TaTME) using the Senhance® robotic system—A video vignette. Color. Dis. 2020, 22, 114–115. [Google Scholar] [CrossRef]
  23. Samalavicius, N.E.; Klimasauskiene, V.; Janusonis, V.; Samalavicius, R.S.; Janusonis, T.; Dulskas, A. Abdominoperineal resection for low rectal neuroendocrine carcinoma after neoadjuvant chemotherapy using the Senhance robotic system with articulating Radia instrument—A Video Vignette. Color. Dis. 2022, 24, 798–799. [Google Scholar] [CrossRef]
  24. Samalavicius, N.E.; Klimasauskiene, V.; Nausediene, V.; Janusonyte-Mongirdiene, H.; Liekis, A.; Dulskas, A. Sigmoid colon resection for sigmoid cancer using a Senhance robotic system and indocyanine green fluorescent angiography-a video correspondence. Color. Dis. 2023, 25, 1062–1063. [Google Scholar] [CrossRef] [PubMed]
  25. Kataoka, A.; Hirano, Y.; Kondo, H.; Shimamura, S.; Kataoka, M.; Asari, M.; Fujii, T.; Ishikawa, S.; Ishii, T.; Yamaguchi, S. Right hemicolectomy with D3 lymph node dissection for right-sided transverse colon cancer using the Senhance robotic system: A case report. Surg. Case Rep. 2020, 6, 263. [Google Scholar] [CrossRef] [PubMed]
  26. Kondo, H.; Yamaguchi, S.; Hirano, Y.; Ishii, T.; Obara, N.; Wang, L.; Asari, M.; Kato, T.; Takayama, T.; Sugita, H.; et al. A first case of ileocecal resection using a Senhance Surgical System in Japan. Surg. Case Rep. 2020, 6, 95. [Google Scholar] [CrossRef] [PubMed]
  27. Campagna, G.; Panico, G.; Vacca, L.; Caramazza, D.; Mastrovito, S.; Lombisani, A.; Ercoli, A.; Scambia, G. Robotic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse using the new Hugo RAS system. Tech. Coloproctol. 2023, 27, 499–500. [Google Scholar] [CrossRef] [PubMed]
  28. Piozzi, G.N.; Lee, D.Y.; Kim, J.S.; Kim, S.H. Da Vinci Single-Port (SP) robotic transverse colectomy for mid-transverse colon cancer. Tech. Coloproctol. 2022, 26, 681–682. [Google Scholar] [CrossRef] [PubMed]
  29. Choo, J.M.; Kim, J.S.; Cheong, J.Y.; Rusli, S.M.; Park, H.; Kim, S.H. Application of a Single-Port Robotic System for Right Colectomy: A Novel Suprapubic Approach. Dis. Colon. Rectum 2022, 65, e1029. [Google Scholar] [CrossRef]
  30. Cheong, J.Y.; Choo, J.M.; Kim, J.S.; Rusli, S.M.; Kim, J.; Kim, S.H. Da Vinci SP System Optimized for Intersphincteric Resection of Very Low Rectal Cancer. Dis. Colon. Rectum 2022, 65, e174. [Google Scholar] [CrossRef]
  31. Marks, J.H.; Salem, J.F.; Anderson, B.K.; Josse, J.M.; Schoonyoung, H.P. Single-port robotic left colectomy: First clinical experience using the SP robot (rSILS). Tech. Coloproctol. 2020, 24, 57–63. [Google Scholar] [CrossRef]
  32. Arezzo, A.; Forcignanò, E.; Morino, M. Robotic endoscopic submucosal dissection and full-thickness excision for laterally spreading tumors of the rectum. Minim. Invasive Ther. Allied Technol. 2022, 31, 377–379. [Google Scholar] [CrossRef]
  33. Marks, J.H.; Kunkel, E.; Salem, J.; Martin, C.; Schoonyoung, H.P.; Agarwal, S. rSILS: Initial clinical experience with single-port robotic (SPr) right colectomy. Tech. Coloproctol. 2020, 24, 817–822. [Google Scholar] [CrossRef]
  34. Marks, J.H.; Kunkel, E.; Salem, J.F.; Martin, C.; Anderson, B.; Agarwal, S. First clinical experience with single-port robotic transanal minimally invasive surgery (SP rTAMIS) for benign rectal neoplasms. Tech. Coloproctol. 2021, 25, 117–124. [Google Scholar] [CrossRef] [PubMed]
  35. Marks, J.H.; Agarwal, S.; Kunkel, E.; Schoonyoung, H.; Salem, J.F. Video Demonstration of an Initial Single-Port Robotic Transanal Total Mesorectal Excision. Dis. Colon. Rectum 2021, 64, e472–e473. [Google Scholar] [CrossRef] [PubMed]
  36. Marks, J.H.; Salem, J.F.; Adams, P.; Sun, T.; Kunkel, E.; Schoonyoung, H.; Agarwal, S. SP rTaTME: Initial clinical experience with single-port robotic transanal total mesorectal excision (SP rTaTME). Tech. Coloproctol. 2021, 25, 721–726. [Google Scholar] [CrossRef] [PubMed]
  37. Kim, W.J.; Park, P.J.; Choi, S.B.; Kim, W.B. Case report of pure single-port robotic left lateral sectionectomy using the da Vinci SP system. Medicine 2021, 100, e28248. [Google Scholar] [CrossRef]
  38. Kang, I.; Hwang, H.K.; Lee, W.J.; Kang, C.M. First experience of pancreaticoduodenectomy using Revo-i in a patient with insulinoma. Ann. Hepatobiliary Pancreat. Surg. 2020, 24, 104–108. [Google Scholar] [CrossRef] [PubMed]
  39. Ku, G.; Kang, I.; Lee, W.J.; Kang, C.M. Revo-i assisted robotic central pancreatectomy. Ann. Hepatobiliary Pancreat. Surg. 2020, 24, 547–550. [Google Scholar] [CrossRef]
  40. Park, H.S.; Lee, J.; Lee, H.; Lee, K.; Song, S.Y.; Toesca, A. Development of Robotic Mastectomy Using a Single-Port Surgical Robot System. J. Breast Cancer 2020, 23, 107–112. [Google Scholar] [CrossRef]
  41. Joo, O.Y.; Song, S.Y.; Park, H.S.; Roh, T.S. Single-port robot-assisted prosthetic breast reconstruction with the da Vinci SP Surgical System: First clinical report. Arch. Plast. Surg. 2021, 48, 194–198. [Google Scholar] [CrossRef]
  42. Dreifuss, N.H.; Schlottmann, F.; Cubisino, A.; Bianco, F.M. Novel surgical approach for gastric gastrointestinal stromal tumor (GIST): Robotic single port partial gastrectomy. Surg. Oncol. 2022, 40, 101704. [Google Scholar] [CrossRef]
  43. Sugita, H.; Sakuramoto, S.; Aoyama, J.; Ito, S.; Oya, S.; Watanabe, K.; Fujiwara, N.; Kondo, H.; Miyawaki, Y.; Hirano, Y.; et al. First experience using the Senhance surgical system in laparoscopic local gastrectomy for gastrointestinal stromal tumor. Asian J. Endosc. Surg. 2021, 14, 790–793. [Google Scholar] [CrossRef]
  44. Cui, H.; Cui, J.X.; Zhang, K.C.; Liang, W.Q.; Li, S.Y.; Huang, J.; Chen, L.; Wei, B. Can a single-port robot be safely used for robotic total gastrectomy for advanced gastric cancer? First experience using the da Vinci SP platform. Gastroenterol. Rep. 2022, 10, goac023. [Google Scholar] [CrossRef] [PubMed]
  45. Cubisino, A.; Dreifuss, N.H.; Schlottmann, F.; Baz, C.; Mangano, A.; Masrur, M.A.; Bianco, F.M. Robotic single port anti-reflux surgery: Initial worldwide experience of two cases with a novel surgical approach to treat gastroesophageal reflux disease. Int. J. Med. Robot. 2022, 18, e2437. [Google Scholar] [CrossRef] [PubMed]
  46. Halabi, M.; Abid, G.; Zenilman, M.E.; Moussa, H. Treatment of an unusual case of Meckel’s diverticulum with a new robotic platform. Int. J. Surg. Case Rep. 2022, 99, 107613. [Google Scholar] [CrossRef]
  47. Dixon, F.; Qureshi, A.; Vitish-Sharma, P.; Khanna, A.; Keeler, B.D. Implementation of robotic hernia surgery using the Versius® system. J. Robot. Surg. 2022, 17, 565–569. [Google Scholar] [CrossRef] [PubMed]
  48. Samalavicius, N.E.; Dulskas, A.; Sirvys, A.; Klimasauskiene, V.; Janusonis, V.; Janusonis, T.; Eismontas, V.; Deduchovas, O.; Stephan, D.; Darwich, I.; et al. Inguinal hernia TAPP repair using Senhance® robotic platform: First multicenter report from the TRUST registry. Hernia 2022, 26, 1041–1046. [Google Scholar] [CrossRef] [PubMed]
  49. Schmitz, R.; Willeke, F.; Barr, J.; Scheidt, M.; Saelzer, H.; Darwich, I.; Zani, S.; Stephan, D. Robotic Inguinal Hernia Repair (TAPP) First Experience with the New Senhance Robotic System. Surg. Technol. Int. 2019, 34, 243–249. [Google Scholar]
  50. Aggarwal, R.; Winter Beatty, J.; Kinross, J.; von Roon, A.; Darzi, A.; Purkayastha, S. Initial Experience With a New Robotic Surgical System for Cholecystectomy. Surg. Innov. 2020, 27, 136–142. [Google Scholar] [CrossRef]
  51. Kelkar, D.S.; Kurlekar, U.; Stevens, L.; Wagholikar, G.D.; Slack, M. An Early Prospective Clinical Study to Evaluate the Safety and Performance of the Versius Surgical System in Robot-Assisted Cholecystectomy. Ann. Surg. 2022, 277, 9–17. [Google Scholar] [CrossRef]
  52. Khanna, S.; Barua, A. Robotic assisted cholecystectomy—A retrospective cohort study of experience of 106 first robotic cholecystectomies in versius robotic platform. Int. J. Surg. Open 2022, 47, 100554. [Google Scholar] [CrossRef]
  53. Lim, J.H.; Lee, W.J.; Choi, S.H.; Kang, C.M. Cholecystectomy using the Revo-i robotic surgical system from Korea: The first clinical study. Updates Surg. 2021, 73, 1029–1035. [Google Scholar] [CrossRef]
  54. Melling, N.; Barr, J.; Schmitz, R.; Polonski, A.; Miro, J.; Ghadban, T.; Wodack, K.; Izbicki, J.; Zani, S.; Perez, D. Robotic cholecystectomy: First experience with the new Senhance robotic system. J. Robot. Surg. 2019, 13, 495–500. [Google Scholar] [CrossRef] [PubMed]
  55. Sasaki, T.; Tomohisa, F.; Nishimura, M.; Arifuku, H.; Ono, T.; Noda, A.; Otsubo, T. Initial 30 cholecystectomy procedures performed with the Senhance digital laparoscopy system. Asian J. Endosc. Surg. 2022, 16, 225–232. [Google Scholar] [CrossRef] [PubMed]
  56. Collins, D.; Paterson, H.M.; Skipworth, R.J.E.; Speake, D. Implementation of the Versius robotic surgical system for colorectal cancer surgery: First clinical experience. Color. Dis. 2021, 23, 1233–1238. [Google Scholar] [CrossRef] [PubMed]
  57. Dixon, F.; O’Hara, R.; Ghuman, N.; Strachan, J.; Khanna, A.; Keeler, B.D. Major colorectal resection is feasible using a new robotic surgical platform: The first report of a case series. Tech. Coloproctol. 2021, 25, 285–289. [Google Scholar] [CrossRef] [PubMed]
  58. Fok, K.Y.; Arabaci, F.; Barto, W. Flexible robotic transanal resection of rectal polyps—A case series. Int. J. Med. Robot. 2022, 18, e2413. [Google Scholar] [CrossRef]
  59. Lin, C.C.; Huang, S.C.; Lin, H.H.; Chang, S.C.; Chen, W.S.; Jiang, J.K. An early experience with the Senhance surgical robotic system in colorectal surgery: A single-institute study. Int. J. Med. Robot. Comput. Assist. Surg. 2021, 17, e2206. [Google Scholar] [CrossRef]
  60. Morino, M.; Forcignanò, E.; Arezzo, A. Initial clinical experience with a novel flexible endoscopic robot for transanal surgery. Tech. Coloproctol. 2022, 26, 301–308. [Google Scholar] [CrossRef]
  61. Noh, G.T.; Oh, B.Y.; Han, M.; Chung, S.S.; Lee, R.A.; Kim, K.H. Initial clinical experience of single-incision robotic colorectal surgery with da Vinci SP platform. Int. J. Med. Robot. 2020, 16, e2091. [Google Scholar] [CrossRef]
  62. Salem, J.F.; Agarwal, S.; Schoonyoung, H.; Martin, C.; Marks, J.H. Initial clinical experience with Single-Port robotic (SP r) left colectomy using the SP surgical system: Description of the technique. Surg. Endosc. 2021, 35, 4022–4027. [Google Scholar] [CrossRef]
  63. Sasaki, M.; Hirano, Y.; Yonezawa, H.; Shimamura, S.; Kataoka, A.; Fujii, T.; Okazaki, N.; Ishikawa, S.; Ishii, T.; Deguchi, K.; et al. Short-term results of robot-assisted colorectal cancer surgery using Senhance Digital Laparoscopy System. Asian J. Endosc. Surg. 2022, 15, 613–618. [Google Scholar] [CrossRef]
  64. Spinelli, A.; David, G.; Gidaro, S.; Carvello, M.; Sacchi, M.; Montorsi, M.; Montroni, I. First experience in colorectal surgery with a new robotic platform with haptic feedback. Color. Dis. 2017, 20, 228–235. [Google Scholar] [CrossRef]
  65. Darwich, I.; Stephan, D.; Klöckner-Lang, M.; Scheidt, M.; Friedberg, R.; Willeke, F. A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance™ Surgical Robotic System: Results and technical aspects. J. Robot. Surg. 2020, 14, 297–304. [Google Scholar] [CrossRef] [Green Version]
  66. Hirano, Y.; Kondo, H.; Yamaguchi, S. Robot-assisted surgery with Senhance robotic system for colon cancer: Our original single-incision plus 2-port procedure and a review of the literature. Tech. Coloproctol. 2021, 25, 467–471. [Google Scholar] [CrossRef]
  67. Huscher, C.; Marchegiani, F.; Cobellis, F.; Tejedor, P.; Pastor, C.; Lazzarin, G.; Wheeler, J.; Di Saverio, S. Robotic oncologic colorectal surgery with a new robotic platform (CMR Versius): Hope or hype? A preliminary experience from a full-robotic case-series. Tech. Coloproctol. 2022, 26, 745–753. [Google Scholar] [CrossRef]
  68. Kim, H.J.; Choi, G.S.; Song, S.H.; Park, J.S.; Park, S.Y.; Lee, S.M.; Choi, J.A. An initial experience with a novel technique of single-port robotic resection for rectal cancer. Tech. Coloproctol. 2021, 25, 857–864. [Google Scholar] [CrossRef] [PubMed]
  69. Li, J.; Zhu, S.; Juan, J.; Yi, B. Preliminary exploration of robotic complete mesocolic excision for colon cancer with the domestically produced Chinese minimally invasive Micro Hand S surgical robot system. Int. J. Med. Robot. 2020, 16, e2148. [Google Scholar] [CrossRef] [PubMed]
  70. Piozzi, G.N.; Kim, J.S.; Choo, J.M.; Shin, S.H.; Kim, J.S.; Lee, T.H.; Baek, S.J.; Kwak, J.M.; Kim, J.; Kim, S.H. Da Vinci SP robotic approach to colorectal surgery: Two specific indications and short-term results. Tech. Coloproctol. 2022, 26, 461–470. [Google Scholar] [CrossRef] [PubMed]
  71. Puntambekar, S.P.; Rajesh, K.N.; Goel, A.; Hivre, M.; Bharambe, S.; Chitale, M.; Panse, M. Colorectal cancer surgery: By Cambridge Medical Robotics Versius Surgical Robot System-a single-institution study. Our experience. J. Robot. Surg. 2022, 16, 587–596. [Google Scholar] [CrossRef]
  72. Samalavicius, N.E.; Dulskas, A.; Janusonis, V.; Klimasauskiene, V.; Eismontas, V.; Deduchovas, O.; Janusonis, T.; Markelis, R.; Smolskas, E. Robotic colorectal surgery using the Senhance® robotic system: A single center experience. Tech. Coloproctol. 2022, 26, 437–442. [Google Scholar] [CrossRef]
  73. Song, S.H.; Kim, H.J.; Choi, G.S.; Park, J.S.; Park, S.Y.; Lee, S.M.; Choi, J.A. Initial experience with a suprapubic single-port robotic right hemicolectomy in patients with colon cancer. Tech. Coloproctol. 2021, 25, 1065–1071. [Google Scholar] [CrossRef]
  74. Liu, S.; Kelley, S.R.; Behm, K.T. Single-port robotic transanal minimally invasive surgery (SPR-TAMIS) approach to local excision of rectal tumors. Tech. Coloproctol. 2021, 25, 229–234. [Google Scholar] [CrossRef] [PubMed]
  75. Marks, J.H.; Kunkel, E.; Salem, J.F.; Martin, C.T.; Anderson, B.; Agarwal, S. First Clinical Experience With Single-Port Robotic Transanal Minimally Invasive Surgery: Phase II Trial of the Initial 26 Cases. Dis. Colon. Rectum 2021, 64, 1003–1013. [Google Scholar] [CrossRef] [PubMed]
  76. Knezevic, N.; Penezic, L.; Kulis, T.; Zekulic, T.; Saic, H.; Hudolin, T.; Kastelan, Z. Senhance robot-assisted adrenalectomy: A case series. Croat. Med. J. 2022, 63, 197–201. [Google Scholar] [CrossRef] [PubMed]
  77. Raffaelli, M.; Gallucci, P.; Voloudakis, N.; Pennestrì, F.; De Cicco, R.; Arcuri, G.; De Crea, C.; Bellantone, R. The new robotic platform Hugo™ RAS for lateral transabdominal adrenalectomy: A first world report of a series of five cases. Updates Surg. 2023, 75, 217–225. [Google Scholar] [CrossRef] [PubMed]
  78. Choi, Y.J.; Jo, H.S.; Kim, D.S.; Yu, Y.D. Single-port robot plus one port (SP + 1) distal pancreatectomy using the new da Vinci SP system. Langenbecks Arch. Surg. 2022, 407, 1271–1276. [Google Scholar] [CrossRef] [PubMed]
  79. Liu, R.; Liu, Q.; Zhao, G.; Zhao, Z.; Li, M.; Gao, Y. Single-port (SP) robotic pancreatic surgery using the da Vinci SP system: A retrospective study on prospectively collected data in a consecutive patient cohort. Int. J. Surg. 2022, 104, 106782. [Google Scholar] [CrossRef]
  80. Go, J.; Ahn, J.H.; Park, J.M.; Choi, S.B.; Lee, J.; Kim, J.Y.; Park, H.S. Analysis of robot-assisted nipple-sparing mastectomy using the da Vinci SP system. J. Surg. Oncol. 2022, 126, 417–424. [Google Scholar] [CrossRef]
  81. Ho, J.; Kim, D.; Lee, J.E.; Kim, J.K.; Lee, C.R.; Kang, S.W.; Jeong, J.J.; Nam, K.H.; Chung, W.Y. Single-Port Transaxillary Robotic Modified Radical Neck Dissection (STAR-RND): Initial Experiences. Laryngoscope 2022, 133, 709–714. [Google Scholar] [CrossRef]
  82. Kim, K.; Kang, S.W.; Kim, J.K.; Lee, C.R.; Lee, J.; Jeong, J.J.; Nam, K.H.; Chung, W.Y. Robotic Transaxillary Hemithyroidectomy Using the da Vinci SP Robotic System: Initial Experience With 10 Consecutive Cases. Surg. Innov. 2020, 27, 256–264. [Google Scholar] [CrossRef]
  83. Park, J.; Kang, L.K.; Kim, K.; Bae, J.S.; Kim, J.S. The learning curve for single-port transaxillary robotic thyroidectomy (SP-TART): Experience through initial 50 cases of lobectomy. Updates Surg. 2022, 75, 691–700. [Google Scholar] [CrossRef]
  84. Li, W.; Kong, K.; Li, P.; Wang, G.; Cui, B.; Zhu, L.; Zhu, S. Robot-assisted sleeve gastrectomy in patients with obesity with a novel Chinese domestic MicroHand SII surgical system. BMC Surg. 2021, 21, 260. [Google Scholar] [CrossRef]
  85. Puntambekar, S.; Bharambe, S.; Pawar, S.; Chitale, M.; Panse, M. Feasibility of transthoracic esophagectomy with a next-generation surgical robot. Sci. Rep. 2022, 12, 17925. [Google Scholar] [CrossRef]
  86. Schmitz, R.; Willeke, F.; Darwich, I.; Kloeckner-Lang, S.M.; Saelzer, H.; Labenz, J.; Borkenstein, D.P.; Zani, S. Robotic-Assisted Nissen Fundoplication with the Senhance® Surgical System: Technical Aspects and Early Results. Surg. Technol. Int. 2019, 35, 113–119. [Google Scholar]
  87. Bianco, F.M.; Dreifuss, N.H.; Chang, B.; Schlottmann, F.; Cubisino, A.; Mangano, A.; Pavelko, Y.; Masrur, M.A.; Giulianotti, P.C. Robotic single-port surgery: Preliminary experience in general surgery. Int. J. Med. Robot. 2022, 18, e2453. [Google Scholar] [CrossRef]
  88. deBeche-Adams, T.; Eubanks, W.S.; de la Fuente, S.G. Early experience with the Senhance®-laparoscopic/robotic platform in the US. J. Robot. Surg. 2019, 13, 357–359. [Google Scholar] [CrossRef]
  89. Dixon, F.; Khanna, A.; Vitish-Sharma, P.; Singh, N.S.; Nakade, K.; Singh, A.; Qureshi, A.; O’Hara, R.; Keeler, B.D. Initiation and feasibility of a multi-specialty minimally invasive surgical programme using a novel robotic system: A case series. Int. J. Surg. 2021, 96, 106182. [Google Scholar] [CrossRef] [PubMed]
  90. El Dahdah, J.; Halabi, M.; Kamal, J.; Zenilman, M.E.; Moussa, H. Initial experience with a novel robotic surgical system in abdominal surgery. J. Robot. Surg. 2022, 17, 841–846. [Google Scholar] [CrossRef] [PubMed]
  91. Kelkar, D.; Borse, M.A.; Godbole, G.P.; Kurlekar, U.; Slack, M. Interim safety analysis of the first-in-human clinical trial of the Versius surgical system, a new robot-assisted device for use in minimal access surgery. Surg. Endosc. 2021, 35, 5193–5202. [Google Scholar] [CrossRef] [PubMed]
  92. Montlouis-Calixte, J.; Ripamonti, B.; Barabino, G.; Corsini, T.; Chauleur, C. Senhance 3-mm robot-assisted surgery: Experience on first 14 patients in France. J. Robot. Surg. 2019, 13, 643–647. [Google Scholar] [CrossRef]
  93. Samalavicius, N.E.; Janusonis, V.; Siaulys, R.; Jasėnas, M.; Deduchovas, O.; Venckus, R.; Ezerskiene, V.; Paskeviciute, R.; Klimaviciute, G. Robotic surgery using Senhance® robotic platform: Single center experience with first 100 cases. J. Robot. Surg. 2020, 14, 371–376. [Google Scholar] [CrossRef]
  94. Stephan, D.; Darwich, I.; Willeke, F. The TransEnterix European Patient Registry for Robotic-Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery (“TRUST”). Surg. Technol. Int. 2021, 38, 103–107. [Google Scholar] [PubMed]
  95. Wehrmann, S.; Tischendorf, K.; Mehlhorn, T.; Lorenz, A.; Gündel, M.; Rudolph, H.; Mirow, L. Clinical implementation of the Versius robotic surgical system in visceral surgery-A single centre experience and review of the first 175 patients. Surg. Endosc. 2023, 37, 528–534. [Google Scholar] [CrossRef] [PubMed]
  96. Yao, Y.; Liu, Y.; Li, Z.; Yi, B.; Wang, G.; Zhu, S. Chinese surgical robot micro hand S: A consecutive case series in general surgery. Int. J. Surg. 2020, 75, 55–59. [Google Scholar] [CrossRef] [PubMed]
  97. Yi, B.; Wang, G.; Li, J.; Jiang, J.; Son, Z.; Su, H.; Zhu, S.; Wang, S. Domestically produced Chinese minimally invasive surgical robot system “Micro Hand S” is applied to clinical surgery preliminarily in China. Surg. Endosc. 2017, 31, 487–493. [Google Scholar] [CrossRef]
  98. Yi, B.; Wang, G.; Li, J.; Jiang, J.; Son, Z.; Su, H.; Zhu, S. The first clinical use of domestically produced Chinese minimally invasive surgical robot system “Micro Hand S”. Surg. Endosc. 2016, 30, 2649–2655. [Google Scholar] [CrossRef]
  99. Dreifuss, N.H.; Chang, B.; Schlottmann, F.; Cubisino, A.; Mangano, A.; Masrur, M.A.; Bianco, F.M. Robotic inguinal hernia repair: Is the new Da Vinci single port platform providing any benefit? Surg. Endosc. 2022, 37, 2003–2013. [Google Scholar] [CrossRef]
  100. Kang, Y.H.; Kang, J.S.; Cho, Y.S.; Kim, H.S.; Lee, M.; Han, Y.; Sohn, H.J.; Kim, H.; Kwon, W.; Jang, J.Y.; et al. A retrospective multicentre study on the evaluation of perioperative outcomes of single-port robotic cholecystectomy comparing the ** and SP versions of the da Vinci robotic surgical system. Int. J. Med. Robot. 2022, 18, e2345. [Google Scholar] [CrossRef]
  101. Kim, W.J.; Choi, S.B.; Kim, W.B. Feasibility and Efficacy of Single-Port Robotic Cholecystectomy Using the da Vinci SP® Platform. JSLS J. Soc. Laparosc. Robot. Surg. 2022, 26, e2021.00091. [Google Scholar] [CrossRef]
  102. Samalavicius, N.E.; Kaminskas, T.; Zidonis, Z.; Janusonis, V.; Deduchovas, O.; Eismontas, V.; Nausediene, V.; Dulskas, A. Robotic cholecystectomy using Senhance robotic platform versus laparoscopic conventional cholecystectomy: A propensity score analysis. Acta Chir. Belg. 2022, 122, 160–163. [Google Scholar] [CrossRef]
  103. Wang, G.; Yi, B.; Li, Z.; Zhu, L.; Hao, L.; Zeng, Y.; Zhu, S. Micro-Hand Robot-Assisted Versus da Vinci Robot-Assisted Cholecystectomy: A Multi-centre, Randomized Controlled Trial. World J. Surg. 2022, 46, 2632–2641. [Google Scholar] [CrossRef]
  104. Jiang, J.; Zhu, S.; Yi, B.; Li, J. Comparison of the short-term operative, Oncological, and Functional Outcomes between two types of robot-assisted total mesorectal excision for rectal cancer: Da Vinci versus Micro Hand S surgical robot. Int. J. Med. Robot. 2021, 17, e2260. [Google Scholar] [CrossRef] [PubMed]
  105. Lei, Y.; Jiang, J.; Zhu, S.; Yi, B.; Li, J. Comparison of the short-term efficacy of two types of robotic total mesorectal excision for rectal cancer. Tech. Coloproctol. 2022, 26, 19–28. [Google Scholar] [CrossRef] [PubMed]
  106. Liu, Y.; Liu, M.; Lei, Y.; Zhang, H.; **e, J.; Zhu, S.; Jiang, J.; Li, J.; Yi, B. Evaluation of effect of robotic versus laparoscopic surgical technology on genitourinary function after total mesorectal excision for rectal cancer. Int. J. Surg. 2022, 104, 106800. [Google Scholar] [CrossRef] [PubMed]
  107. Luo, D.; Liu, Y.; Zhu, H.; Li, X.; Gao, W.; Li, X.; Zhu, S.; Yu, X. The MicroHand S robotic-assisted versus Da Vinci robotic-assisted radical resection for patients with sigmoid colon cancer: A single-center retrospective study. Surg. Endosc. 2020, 34, 3368–3374. [Google Scholar] [CrossRef] [PubMed]
  108. Wang, Y.; Li, Z.; Yi, B.; Zhu, S. Initial experience of Chinese surgical robot “Micro Hand S’’-assisted versus open and laparoscopic total mesorectal excision for rectal cancer: Short-term outcomes in a single center. Asian J. Surg. 2022, 45, 299–306. [Google Scholar] [CrossRef]
  109. Wang, Y.; Wang, G.; Li, Z.; Ling, H.; Yi, B.; Zhu, S. Comparison of the operative outcomes and learning curves between laparoscopic and “Micro Hand S” robot-assisted total mesorectal excision for rectal cancer: A retrospective study. BMC Gastroenterol. 2021, 21, 251. [Google Scholar] [CrossRef]
  110. Zeng, Y.; Wang, G.; Li, Z.; Lin, H.; Zhu, S.; Yi, B. The Micro Hand S vs. da Vinci Surgical Robot-Assisted Surgery on Total Mesorectal Excision: Short-Term Outcomes Using Propensity Score Matching Analysis. Front. Surg. 2021, 8, 656270. [Google Scholar] [CrossRef]
  111. Zeng, Y.; Wang, G.; Liu, Y.; Li, Z.; Yi, B.; Zhu, S. The “Micro Hand S” Robot-Assisted Versus Conventional Laparoscopic Right Colectomy: Short-Term Outcomes at a Single Center. J. Laparoendosc. Adv. Surg. Tech. A 2020, 30, 363–368. [Google Scholar] [CrossRef]
  112. Lee, I.A.; Kim, J.K.; Kim, K.; Kang, S.W.; Lee, J.; Jeong, J.J.; Nam, K.H.; Chung, W.Y. Robotic Adrenalectomy Using the da Vinci SP Robotic System: Technical Feasibility Comparison with Single-Port Access Using the da Vinci Multi-arm Robotic System. Ann. Surg. Oncol. 2022, 29, 3085–3092. [Google Scholar] [CrossRef]
  113. Kim, J.K.; Choi, S.H.; Choi, S.M.; Choi, H.R.; Lee, C.R.; Kang, S.W.; Jeong, J.J.; Nam, K.H.; Chung, W.Y. Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method. Surg. Endosc. 2022, 36, 2688–2696. [Google Scholar] [CrossRef]
  114. Cambridge Medical Robotics. 10,000 Cases—Making Every Procedure Count. Available online: https://cmrsurgical.com/features/making-every-procedure-count (accessed on 23 May 2023).
  115. Cambridge Medical Robotics. CMR Surgical Announces More Than 100 Versius Systems Installed Globally. Available online: https://cmrsurgical.com/news/cmr-announces-more-than-100-systems-installed (accessed on 23 May 2023).
  116. Intuitive Surgical. Annual Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934—Form 10-K. Available online: https://isrg.intuitive.com/static-files/f9d16f73-dcea-419e-ac73-7ae13b86c207 (accessed on 23 May 2023).
  117. Asensus. Asensus Surgical Provides Corporate Update. Available online: https://ir.asensus.com/news-releases/news-release-details/asensus-surgical-provides-corporate-update (accessed on 23 May 2023).
  118. Japan 2 Earth. Japan’s First Surgical Robot: Technological Innovation in the World of Medicine. Available online: https://featured.japan-forward.com/japan2earth/2023/01/2034/ (accessed on 23 May 2023).
  119. Avateramedical. Avateramedical Robot-Assisted Surgery System Progresses to Clinical Use. Available online: https://www.avatera.eu/en/company/news/detail?tx_news_pi1%5Bnews%5D=42&cHash=84ba505a890ba27dcf6bec17706087cf (accessed on 23 May 2023).
  120. Distalmotion. Available online: https://www.distalmotion.com/news (accessed on 23 May 2023).
  121. SAGES. Moon Surgical Maestro Surgical Robotics System. Available online: https://www.sages.org/publications/tavac/moon-surgical-maestro-surgical-robotics-system/ (accessed on 23 May 2023).
  122. Madanapalle, A. ‘Made in India’ Surgical Robot SSI Mantra Completes 100 Successful Surgeries. Available online: https://www.news9live.com/health/medicine/made-in-india-surgical-robot-ssi-mantra-completes-100-successful-surgeries-au941-2068412 (accessed on 23 May 2023).
  123. RobSurgical. Rob Surgical Receives Authorisation to Conduct Fih Clinical Trials. Available online: https://www.robsurgical.com/rob-surgical-receives-fih-authorisation/ (accessed on 23 May 2023).
  124. Soumpasis, I.; Nashef, S.; Dunning, J.; Moran, P.; Slack, M. Safe Implementation of a Next-Generation Surgical Robot: First Analysis of 2,083 Cases in the Versius Surgical Registry. Ann. Surg. 2023. [Google Scholar] [CrossRef]
  125. Race, A.; Horgan, S. Overview of Current Robotic Technology. In Innovative Endoscopic and Surgical Technology in the GI Tract; Horgan, S., Fuchs, K.-H., Eds.; Springer International Publishing: Cham, Switzerland, 2021; pp. 1–17. [Google Scholar] [CrossRef]
  126. Grimsley, E.A.; Barry, T.M.; Janjua, H.; Eguia, E.; DuCoin, C.; Kuo, P.C. Exploring the paradigm of robotic surgery and its contribution to the growth of surgical volume. Surg. Open Sci. 2022, 10, 36–42. [Google Scholar] [CrossRef]
  127. Bianchi, P.P.; Salaj, A.; Rocco, B.; Formisano, G. First worldwide report on Hugo RAS surgical platform in right and left colectomy. Updates Surg. 2023, 75, 775–780. [Google Scholar] [CrossRef] [PubMed]
  128. Quijano, Y.; Vicente, E.; Ferri, V.; Naldini, C.; Pizzuti, G.; Caruso, R. Robot-assisted Nissen fundoplication with the new HUGO Robotic assisted system: First worldwide report with system description, docking settings and video. Int. J. Surg. Case Rep. 2023, 106, 108178. [Google Scholar] [CrossRef]
  129. de’Angelis, N.; Khan, J.; Marchegiani, F.; Bianchi, G.; Aisoni, F.; Alberti, D.; Ansaloni, L.; Biffl, W.; Chiara, O.; Ceccarelli, G.; et al. Robotic surgery in emergency setting: 2021 WSES position paper. World J. Emerg. Surg. 2022, 17, 4. [Google Scholar] [CrossRef]
  130. O’Meara, S. Medical robotics in China: The rise of technology in three charts. Nature 2020, 582, S51–S52. [Google Scholar] [CrossRef]
  131. Guo, Y.; Chen, W.; Zhao, J.; Yang, G.-Z. Medical Robotics: Opportunities in China. Annu. Rev. Control Robot. Auton. Syst. 2022, 5, 361–383. [Google Scholar] [CrossRef]
  132. Harbin Sagebot Intelligent Medical Equipment Co., Ltd. KangDuo Robot Has Passed the Registration Review of the NMPA. Available online: http://www.hrbszr.com (accessed on 23 May 2023).
  133. Medbot. FAHZU Completed the First DomesticChinese-Developed 4-Arm Laparoscopic Robot-Assisted Total Intracavitary Radical Cystectomy & Orthotopic Neobladder in China. Available online: https://www.medbotsurgical.com/ (accessed on 23 May 2023).
  134. Ronovo Surgical. Ronovo Wins Resounding KOL Accolades in Latest Carina™ RAS Platform Animal Labs. Available online: https://www.ronovosurgical.com (accessed on 23 May 2023).
  135. Kikuchi, K.; Suda, K.; Shibasaki, S.; Tanaka, T.; Uyama, I. Challenges in improving the minimal invasiveness of the surgical treatment for gastric cancer using robotic technology. Ann. Gastroenterol. Surg. 2021, 5, 604–613. [Google Scholar] [CrossRef]
  136. Orsi Academy. Orsi Academy Welcomes Medicaroid’s Hinotori™ Surgical Robot System*, a World’s First! Available online: https://www.orsi-online.com/news/worlds-first-orsi-welcomes-hinotoritm-surgical-robot-medicaroid (accessed on 23 May 2023).
  137. Tuliao, P.H.; Kim, S.W.; Rha, K.H. New technologies in robotic surgery: The Korean experience. Curr. Opin. Urol. 2014, 24, 111–117. [Google Scholar] [CrossRef]
  138. Bora, G.S.; Narain, T.A.; Sharma, A.P.; Mavuduru, R.S.; Devana, S.K.; Singh, S.K.; Mandal, A.K. Robot-assisted surgery in India: A SWOT analysis. Indian. J. Urol. 2020, 36, 1–3. [Google Scholar] [CrossRef]
  139. Cisu, T.; Crocerossa, F.; Carbonara, U.; Porpiglia, F.; Autorino, R. New robotic surgical systems in urology: An update. Curr. Opin. Urol. 2021, 31, 37–42. [Google Scholar] [CrossRef] [PubMed]
  140. Lin, H.; Zhang, J.; Li, X.; Li, Y.; Su, S. Comparative outcomes of single-incision laparoscopic, mini-laparoscopic, four-port laparoscopic, three-port laparoscopic, and single-incision robotic cholecystectomy: A systematic review and network meta-analysis. Updates Surg. 2023, 75, 41–51. [Google Scholar] [CrossRef] [PubMed]
  141. de’Angelis, N.; Marchegiani, F.; Schena, C.A.; Khan, J.; Agnoletti, V.; Ansaloni, L.; Barria Rodriguez, A.G.; Bianchi, P.P.; Biffl, W.; Bravi, F.; et al. Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper. World J. Emerg. Surg. 2023, 18, 11. [Google Scholar] [CrossRef] [PubMed]
  142. Stefanidis, D.; Huffman, E.M.; Collins, J.W.; Martino, M.A.; Satava, R.M.; Levy, J.S. Expert Consensus Recommendations for Robotic Surgery Credentialing. Ann. Surg. 2022, 276, 88–93. [Google Scholar] [CrossRef]
  143. Burke, J.R.; Fleming, C.A.; King, M.; El-Sayed, C.; Bolton, W.S.; Munsch, C.; Harji, D.; Bach, S.P.; Collins, J.W. Utilising an accelerated Delphi process to develop consensus on the requirement and components of a pre-procedural core robotic surgery curriculum. J. Robot. Surg. 2023. online ahead of print. [Google Scholar] [CrossRef]
  144. Sighinolfi, M.C.; Terzoni, S.; Scanferla, E.; Bianchi, P.P.; Formisano, G.; Gaia, G.; Marconi, A.M.; Chiumello, D.; Patel, V.; Moschovas, M.C.; et al. Impact of hands-on practice with HugoRAS and Versius System simulators on the attractiveness of robotic surgery among medical and nurse undergraduate students. J. Robot. Surg. 2023. online ahead of print. [Google Scholar] [CrossRef]
  145. Myklebust, M.V.; Storheim, H.; Hartvik, M.; Dysvik, E. Anesthesia Professionals’ Perspectives of Teamwork During Robotic-Assisted Surgery. AORN J. 2020, 111, 87–96. [Google Scholar] [CrossRef]
  146. Larkins, K.M.; Mohan, H.M.; Gray, M.; Costello, D.M.; Costello, A.J.; Heriot, A.G.; Warrier, S.K. Transferability of robotic console skills by early robotic surgeons: A multi-platform crossover trial of simulation training. J. Robot. Surg. 2022, 17, 859–867. [Google Scholar] [CrossRef]
  147. Ghazi, A.; Schuler, N.; Saba, P.; Holler, T.; Steinmetz, A.; Yuen, K.; Doersch, K.; Ellis, E.; Tabayoyong, W.; Bloom, J.; et al. Do Skills Naturally Transfer Between Multiport and Single-Port Robotic Platforms? A Comparative Study in a Simulated Environment. J. Endourol. 2023, 37, 233–239. [Google Scholar] [CrossRef]
  148. Hussein, A.A.; Mohsin, R.; Qureshi, H.; Leghari, R.; **g, Z.; Ramahi, Y.O.; Rizvi, I.; Guru, K.A.; Rizvi, A. Transition from da Vinci to Versius robotic surgical system: Initial experience and outcomes of over 100 consecutive procedures. J. Robot. Surg. 2023, 17, 419–426. [Google Scholar] [CrossRef]
  149. Nakauchi, M.; Suda, K.; Nakamura, K.; Tanaka, T.; Shibasaki, S.; Inaba, K.; Harada, T.; Ohashi, M.; Ohigashi, M.; Kitatsuji, H.; et al. Establishment of a new practical telesurgical platform using the hinotori Surgical Robot System: A preclinical study. Langenbecks Arch. Surg. 2022, 407, 3783–3791. [Google Scholar] [CrossRef]
  150. Asensus. Asensus Surgical Receives CE Mark for Expanded Machine Vision Capabilities. Available online: https://ir.asensus.com/news-releases/news-release-details/asensus-surgical-receives-ce-mark-expanded-machine-vision (accessed on 23 May 2023).
Medicina 59 01264 g001 550
Figure 1. PRISMA flowchart of the literature search and selection.
Figure 1. PRISMA flowchart of the literature search and selection.
Medicina 59 01264 g001
Table
Table 1. Number of interventions according to the surgical specialties and the type of robotic platforms.
Table 1. Number of interventions according to the surgical specialties and the type of robotic platforms.
Robotic
Platform		Intuitive Surgical
Da Vinci SP®		CMR
Versius®		Asensus
Senhance®		Wego
MicroHand S/SII		Medrobotics
Flex®		Meerecompany
Revo-i™		Medtronic
Hugo™ RAS		Total Cases Per
Specialty
Surgical
Specialty
Hepatobiliary3864221149601701035
Colorectal781692512093301741
Abdominal wall89973450000531
Endocrine2985120000315
Upper GI4691932000124
Breast7300000073
Total cases per platform928762741337331712819
Table
Table 2. Regulatory approvals and available information of the robotic platforms.
Table 2. Regulatory approvals and available information of the robotic platforms.
Clinically Adopted Platforms
CompanyProduct NameCountryRegulatory ApprovalsMarketing Information
(n. Procedures/Platform)
MedtronicHugo™ RASUSFDA: ongoing
CE-mark: general surgery; urology; gynecology
Australian TGA: urology; gynecology
Health Canada: general surgery
MHLW PMDA Japan: urology; gynecology		NR
Cambridge Medical RoboticsVersius®EnglandCE-mark: general surgery; urology; gynecology; thoracic surgery
Australian TGA: general surgery; urology; gynecology
Anvisa Brazil: general surgery; urology; gynecology
Other countries: India; Pakistan; Egypt		10,000 procedures performed (March 2023) [114]
>100 installed platforms (November 2022) [115]
Intuitive SurgicalDa Vinci SP®USFDA: urology; transoral procedures
MHLW PMDA Japan: urology; gynecology; general surgery; thoracic surgery; transoral
MFDS Korea: urology; general surgery; gynecology; thoracic surgery; transoral
NMPA China: yes, not specified		121 installed platform (December 2022) [116]
A’design award winner 2019
Medrobotics Corp.Flex® Robotic SystemUSFDA: transoral; colorectal; general surgery; gynecology; thoracic surgery
CE-mark: colorectal
Australian TGA: colorectal		Bankrupt of the producing company
Asensus
(formerly TransEnterix)		Senhance® ALF-XUSFDA: general surgery; gynecology. Pediatric surgery expected in 2023
CE-mark: general surgery; gynecology; pediatric surgery
MHLW PMDA Japan: urology; gynecology; general surgery; thoracic surgery
Roszdravnadzor—Russia: yes, not specified
Taiwan: yes, not specified		>10,000 procedures performed (February 2023)
>49 installed platforms between 2016 and 2022 [117]
Meerecompany Inc.Revo-i™South KoreaMFDS Korea: urology; gynecology; general surgeryNR
WegoMicro Hand SChinaNMPA China: general surgeryReddot award winner 2022
Platforms under Clinical Investigation
CompanyProduct NameCountryRegulatory ApprovalsMarketing Information
MedicaroidHinotori™JapanMHLW PMDA Japan: urology; gastrointestinal; gynecology840 procedures (December 2022)
28 installed platforms (September 2022) [118]
Avatera MedicalAvateraGermanyCE-mark: urology; gynecologyFist clinical procedure in May 2022 [119]
DistalmotionDexterSwitzerlandCE-mark: general surgery; gynecology4 installed platforms [120]
iF design award 2020
Moon SurgicalMaestroUSFDA: laparoscopic procedures
CE-mark: laparoscopic procedures		30 procedures performed [121]
Virtual IncisionMIRAUSFDA: completed IDE for bowel resections. De novo classification pathway ongoingNR
Titan Medical Inc.ENOS™ (formerly SPORT)CanadaFDA: planned in 2023
CE-mark: planned in 2023/24		NR
SS InnovationMantraIndiaFDA: planned in 2023
CE-mark: planned in 2023
Other countries: India		5 installed platforms
100 procedures performed [122]
Rob Surgical Systems SBitrack SystemSpainNRFirst clinical trial ongoing [123]
US: United States; FDA: food and drug administration; CE: Conformité Europeenne; TGA: Therapeutic Goods Administration; MHLW PMDA: Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency; NR: not reported; MFDS: Ministry of Food and Drug Safety; NMPA: National Medical Products Administration; IDE: Investigational Device Exemption.
Table
Table 3. Summary of the overall characteristics of the robotic platforms.
Table 3. Summary of the overall characteristics of the robotic platforms.
Robotic PlatformPatient Chart ArchitectureConsole ArchitectureOperative Arms No.TrocarsInstrumentsInstruments’ ReusabilityAdvanced Energy
Medtronic
Hugo™ RAS		ModularOpen3CommercialWristedReusables (some disposables)NA
Cambridge Medical Robotics
Versius®		ModularOpen3CommercialWristedReusablesNA
Intuitive Surgical
Da Vinci SP®		Single portClosed3Dedicated + commercialWristedReusablesNA
Medrobotics Corp.
Flex® Robotic System		Flexible system/2/WristedDisposablesNA
Asensus
Senhance® ALF-X		ModularOpen3CommercialRigid with a kit of wristedReusablesUltrasonic (rigid)
Meerecompany Inc.
Revo-i™		MultiarmClosed3CommercialWristedReusablesUltrasonic (rigid)
Wego
Micro Hand S		MultiarmOpen2DedicatedWristedReusablesUltrasonic (rigid)
Medicaroid
Hinotori™		MultiarmSemi-open3DedicatedWristedReusablesNA
Avatera Medical
Avatera		MultiarmSemi-open3NRWristedDisposablesNA
Distalmotion
Dexter		ModularOpen (with laparoscopic screen)2CommercialWristedDisposablesNA
Moon Surgical
Maestro		Multiport instrument holder/1Commercial//NA
Virtual Incision
MIRA		Single portOpen2NRWristedReusablesNA
Titan Medical Inc.
ENOS™ (formerly SPORT)		Single portOpen2NRWristedReusablesNA
SS Innovation
Mantra		ModularOpen3DedicatedWristedReusablesNA
Rob Surgical Systems S
Bitrack System		MultiarmOpen3CommercialWristedDisposablesNA
NR: not reported; NA: not available.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Marchegiani, F.; Siragusa, L.; Zadoroznyj, A.; Laterza, V.; Mangana, O.; Schena, C.A.; Ammendola, M.; Memeo, R.; Bianchi, P.P.; Spinoglio, G.; et al. New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario? Medicina 2023, 59, 1264. https://doi.org/10.3390/medicina59071264

AMA Style

Marchegiani F, Siragusa L, Zadoroznyj A, Laterza V, Mangana O, Schena CA, Ammendola M, Memeo R, Bianchi PP, Spinoglio G, et al. New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario? Medicina. 2023; 59(7):1264. https://doi.org/10.3390/medicina59071264

Chicago/Turabian Style

Marchegiani, Francesco, Leandro Siragusa, Alizée Zadoroznyj, Vito Laterza, Orsalia Mangana, Carlo Alberto Schena, Michele Ammendola, Riccardo Memeo, Paolo Pietro Bianchi, Giuseppe Spinoglio, and et al. 2023. "New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario?" Medicina 59, no. 7: 1264. https://doi.org/10.3390/medicina59071264

Article Metrics

Back to TopTop