(UroToday.com) During the inaugural plenary session on the first day of the 2024 WCET Meeting, Dr. Lui Shong Lee, MBBS, MRCS, FAMS, moderated a panel discussion regarding multi and single-port robotic platforms. Among the panelists, Dr. Benjamin I Chung, MD, Dr. Ken-ichi Tabata, and Dr. Sung-Hoo Hong, MD, PhD provided insight into this thought-provoking discussion.
Opening with “Multiport Robot with Branching Arms”, Dr. Chung of Stanford Urology reviewed the evolution of robotic technology dating back to 1999 which has primarily been concerned with multi-port robots (Figure 1).
Figure 1. Evolution of surgical robotic technology since 1999.
This further contributed to a multiport branching paradigm, wherein various robotic platforms have been at the forefront of surgical technology; however, there have been considerable advances including modular robotic arms, microrobots, and single port systems. Moreover, multiport platforms have been upgraded since 2014 emphasizing the requirement for more surgeon autonomy while in the operating room. With the evolution of such platforms, ergonomics has become more streamlined. “So why should we continue to utilize a multiport branched arm? This is something that has been widely adopted and utilized over many specialties across the world.” He continued his discussion sharing advantages as there is widespread familiarity with the system, the ergonomic console, haptic feedback, and surgeon autonomy. When considering the introduction of novel system, he voiced concern regarding potential problems and limited data when comparing system types. For Dr. Chung, he believes single port systems in particular do not meet a ‘one size fits all’ component, which limit the type of procedures that can be performed under this platform. Despite these critiques, he does suggest that they can potentially allow for ease of access into extraperitoneal and retroperitoneal spaces, as well as employ a more flexible camera. On the other hand, modular systems, which are not currently approved in the United States, create larger footprints which may lead to an increase in instrument collisions. Overall, he does affirm that multiport branched arms are the dominant paradigm, while other platforms have limitations that have yet to be overcome.
Following this review, Dr. Tabata of the Kitasato Institute Hospital commenced his discussion of the “Multi-Port Robot with Module-Based System (Hugo RAS System)”, a platform that his group has been utilizing since 2023. To provide a foundation, he shared the dominant surgical robots used across the world, with Japan primarily using the Saroa and Hinotori. Among the variety of robots used globally, 71% are open consoles, while the remaining are independent arms, further suggesting there is no definitive platform of choice. As it stands, there are 12 Hugo systems. Since starting last year, Dr. Tabata and colleagues have performed 93 cases, with a common setup as seen below (Figure 2).
Figure 2. RAS set up.
Notably, docking and undocking do require an increased set-up time, however this may decrease to 3-4 after 10 cases. The hand control additionally does not have full finger rotation, requiring rotation of the forearm. Furthermore, console time Is slightly longer but not significantly different from the da Vinci system. In sum, from Dr. Tabat’s experience, the short-term surgical results of the HUGO system are comparable to those with the da Vinci, as the learning curve is associated.
Prior to concluding this session, Dr. Hong approached the stage to discuss the single-port robots. He immediately began with the advantages and disadvantages of single port robots, noting their optimization for minimally invasive surgery, easy docking experience, and small working space, however, he also reviewed their limited range of motion, weak traction power, wrist fighting mechanism, and decreased ergonomic factors. In an open nephroureterectomy, wherein there exists no ideal port configuration for kidney and pelvis access. With a single port, this limitation was vanquished. Moreover, for patients requiring radical prostatectomy, the single-port system nearly replicated a similar technique as multi-port robots. Additionally, the “Cobra” mode allowed for the optimal angle for various surgical steps such as tumor resection and suture placement. In brief, single-port systems may become the standard treatment option for selected patients.
All panelists provided a comprehensive review of their respective systems, leaving up for debate the most optimal system.
Moderated by: Dr. Lui Shong Lee, MBBS, MRCS, FAMS Expert Panel:- Dr. Benjamin I. Chung, MD – Multi-Port Robot with Branching Arms
- Dr. Jeremy Teoh, MD – Multi-Port Robot with Module-Based System
- Dr. Sung-Hoo Hong, MD, PhD – Single Port Robot
Written by: Mariah Hernandez, Research Specialist, Department of Urology, University of California Irvine, @mariahch00 on Twitter during the 2024 World Congress of Endourology and Uro-Technology: August 12 -16, 2024, Seoul, South Korea