Abstract
Background
The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and “on-demand” platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework.
Methods
A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature.
Results
21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0.
Conclusions
The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.
Graphical abstract
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Excitement about robotic surgery continues to grow with the obvious benefits in surgeon ergonomics, high-definition 3D vision, dexterity, truly objective metrics for assessment, the application of artificial intelligence and augmented reality. Minimally invasive surgery (MIS) has evidence of non-inferiority in mortality outcomes compared to open surgery, but with superior outcomes in terms of patient morbidity and length of stay [1]. For robotic surgery, evidence is mounting as institutional learning curves are realised and long-term data becomes available, with improved patient outcomes when compared to laparoscopy in terms of morbidity [2,3,4,5,6] including lower blood loss, conversion-to-open, pain and shorter hospital stay. However, the evidence is mixed, for example in a meta-analysis comparing different approaches of total mesorectal excision in rectal cancer [7], and often equivalent outcomes in “smaller” operations [8, 9].
Roughly 82% of robotic surgery performed is within urology, general surgery, and gynaecology [10], but it is still only used in a minority of operations worldwide, due to availability and cost. To address this, many robotic platforms are in development or have recently reached the market, providing competition but also different approaches to broaden the capacity and capabilities of surgeons. As such there has been a rapid increase in robotic operations, one study of 73 hospitals stated an increase of 1.8% to 15.1% of all general surgery procedures were performed robotically between 2012 to 2018 [11] and the robotic surgery market globally was valued at $5.32 billion in 2019, estimated to grow to $19 billion in 2027 [12].
Along with this expansion there have been calls for reporting on safe implementation of novel platforms and standardisation of training and accreditation within robotics, due to concerns over errors and patient safety [13, 14]. Now the surgical community is faced with the additional challenge of evaluating multiple robotic platforms.
To our knowledge, there is no comprehensive, up-to-date review of existing platforms which can help guide the end-user, the surgeon, to decide which robot would be ideal for their purpose and the evidence to support it.
This scoping review aims to provide an update of current and emerging robotic platforms within minimally invasive surgical specialties, including a stage of evaluation using The Idea, Development, Explore, Assessment and Long-term study (IDEAL) Framework [15].
Methods
A scoping review was performed, screening articles from PubMed, Google Scholar, journal reports, company websites and review articles. The search focused on minimally invasive robotic surgical platforms used within general surgery, gynaecology, urology, head and neck, cardiothoracics, given the application is predominantly in these specialties, and robots are broadly comparable in terms of function. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded as these are potentially not comparable.
Information from the public domain was also collected and each company approached via email for virtual interview to discover more about the systems and quality check data collection. This was a structured hour-long interview with a template of questions used (Fig. 1), and the company was given an opportunity for a short presentation. Clinical data to aid the IDEAL stage of evaluation was identified through PubMed, Google and company websites. Data collection included: company, founding year, development and testing including pre-clinical/clinical trials, price, system and device descriptors, training and support available, and additional information distinguishing robots from their competitors. The IDEAL Framework (Fig. 2) was applied to assess the stage of evaluation for each system in the clinical setting. All companies who responded reviewed their respective data in this review as part of the quality assurance process. Results are accurate to the authors’ knowledge at the time of publication, however, may have changed or inaccuracies present, particularly in companies who have not responded.
Results
A total of 36 robotic system platforms were identified for potential data extraction. Of these, 15 were excluded, 10 of which were endoluminal or natural orifice robotic systems and the other 5 were robotic devices rather than surgical systems. A total of 21 robotic platforms were scrutinised for data extraction and analysis, presented in full in Table 1, with accompanying images in Figs. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22.
da Vinci 4th generation robots [101]
Hinotori Surgical Robot, Medicaroid Corporation [102]
WEGO MicroHand S Surgical Robot System [103]
Toumai Laparoscopic Surgical Robot, MEDBOT [104]
Versius Surgical Robotic System, provided by and permission from CMT (left picture- surgeon console and modular bed side units, right picture- hand controller) [105]
MP1000 and SP1000 robots, Shenzen Edge Medical Robotics Co [76]
Shurui Robot, Beijing Shurui Technology Co., Ltd [106]
Bitrack System, RobSurgical [93]
Carina, Ronovo Surgical [94]
Twenty companies were approached via email for virtual interview. Twelve replied, seven met virtually and five via email. Eight companies did not reply and one there was no available email, therefore, the corresponding author of a review paper was approached, again, with no reply. Instead, for these companies, information was collected solely from the public domain.
Of these companies, China and USA have six different platforms each, Germany with two and the UK, Canada, Spain, Republic of Korea, Japan, Switzerland and India all with one platform. There was a total of 23 surgical robots for analysis. Fifteen of 21 companies represent multiport robots, four single ports, and two with both. Of the multiport systems, eight were modular and nine had a single-unit patient console.
Thirteen robotic companies have national or international regulatory approvals, with eight having none, although one robot, DLR MiroSurge from Germany, will never be used in the clinical setting.
All supporting evidence on robotic systems have been reported only in urology, general surgery and gynaecology.
Of the 17 multiport systems, one is fully evaluated at stage 4, two are stage 3, six stage 2b, two stage 2a, two stage 1, and four at the pre-IDEAL stage 0. Of the six single-port systems none have been fully evaluated with one at stage 3, three at stage 1 and two at stage 0. Pooling the 23 systems together; six have been evaluated at stage 0, and 13 at stage 1 to 2b, with four at stage 3 to 4.
Long-term data was reported for three companies. Intuitive Surgical Inc, and Suzhou Kangduo Robot Co., Ltd robotic systems both had randomised control trial data supporting evidence, whilst Asensus Surgical Ltd., have formed a multispecialty registry.
Comparison data is reported for robotic devices and platforms (Table 1). Two studies, a systematic review [21] and meta-analysis [22], found that the da Vinci single port compared to multiport, had reduced time with the catheter post prostatectomy [22], reduced length of hospital stay and opioid/analgesia administration, with equivalent oncological and continence outcomes [21, 22]. The KANGDUO Robot® Surgical System is compared to the da Vinci Si system in two studies, one on robotic assisted radical prostatectomy (RARP) demonstrating comparable short-term functional and oncological outcomes, but longer operating times in 16 patients [41]. The second, a two-centre blinded randomised control trial, showed non-inferiority in robotic assisted partial nephrectomy (RAPN) for T1a renal tumours, but with longer docking and suturing times [42]. The Revo-i system was compared to da Vinci Si in RARP, producing similar short-term functional and oncological outcomes [69]. MicroHand Surgical Robot was compared to da Vinci, reporting shorter length of stay and reduced hospital costs in 45 patients undergoing sigmoidectomy, although did not specify the da Vinci generation [63]. It also demonstrated no difference in faecal continence following total mesorectal excision when compared to da Vinci Si [64] (Table 2).
Comparing total costs, da Vinci X and Xi is reported to be at $1.2 and $2 million respectively and an average cost per operation of $2500 [17], although clearly this will have a significant range. Other comparable systems are touted to be cheaper with KANGDUO at $1 to 1.4million, with no comparable clinical data to X and Xi systems, only Si. The Senhance® Surgical System is stated to cost between $1 to 1.2 million [17], with per procedure comparisons with da Vinci stated to be cheaper in one study, $559 versus $1393, and comparable operative times [44]. Hinotori™ Surgical Robot System and Hugo™ RAS surgical system both state that their system is cheaper than the Xi, and the avatera® system has been quoted at $1.1 million [84].
Discussion
Our review has highlighted that full evaluation for robotic platforms has not been reported even on established robots, with the majority currently validated at stages 0 to 2b. Understandably, Intuitive is the only platform which has been fully evaluated, as it has had over twenty years to achieve long-term outcome, including randomised control trial, data. Publication of full evaluations for other systems is eagerly awaited.
The lack of evaluation reports represents a challenge for the surgical community given the rapid adoption of new systems. This situation, however, is likely to improve with time due to emerging platforms becoming commercially available.
We have provided an initial, comprehensive analysis of the platforms in this review, using The IDEAL Framework. Its intended use is for the evaluation of new, complex treatments within surgery through a logical, methodical pathway. Professor McCulloch (Chair of IDEAL) and the IDEAL team offer an explanation that competition, in this case between robotic companies, can often drive rapid adoption without full evaluation as defined by the framework. Although, safe evaluation exists with regulatory approvals before implementation into the clinical setting, it is possible that devices are introduced too quickly and not fully evaluated for certain procedures, given the increasingly competitive industry. On the other hand, it is worth noting that it would not be possible to reach stage 4 of evaluation without a platform being used in the clinical setting. Other explanations for rapid adoption pertain to the feasibility of performing multiple evaluations, across many different types of operations, within and between specialties. This would require considerable time and is unlikely to be cost-effective for robotic companies to wait for full evaluation [15]. Ultimately this would lead to the failure of bringing many platforms to market and the undesirable outcome of hindering technological progress within surgical specialties. It is also recognised that attitudes and process in healthcare differ worldwide including the adoption of new technology, therefore, evaluation of these will as well. However, broadly speaking clinicians should evaluate outcomes in the same way as IDEAL suggests i.e. through case report and series, prospective observational studies, randomised control trials against the gold standard, and long-term follow-up. Therefore, with rigorous regulatory approval and sound methodology from stage 0 to 2a, implementation of new and emerging robotic platforms is likely to be safe. Regarding long-term outcomes, multicentre, international registries could be an alternative solution to provide large data on evaluation across platforms and specialties with the European Association of Endoscopic Surgery (EAES) well positioned to provide this function for its members and beyond.
Another consideration when discussing further research within this area is whether it could distract or deviate finite resources from other fields in need. However, given that the IDEAL Framework evaluation relies on studies investigating clinical outcomes, the research required is likely to be transferable.
Several comparative studies were highlighted in Table 1, looking at clinical outcomes, however, there is greater research needed in this field. Studies are limited in scope, are often not independent from funding or involvement from the robotic company and none compare their systems to the fourth generation of Intuitive robots which are predominantly in use. Equally, these studies should not be ignored as often they demonstrate non-inferiority to the da Vinci Si i.e. safety of their use and clinical efficacy.
Considering the costs of each system it appears that the da Vinci Xi is the most expensive, but it is perhaps difficult to compare, with Intuitive Surgical Inc. producing its fourth generation. In fact, some of the systems highlighted have been created to have different capabilities and accessibility, therefore will be cheaper, but not comparable. For example, the Revo-I robot has been developed to do just this, improve accessibility, and is currently being used in Uzbekistan. It is also important to note that some of the costings quoted in the table were released by other companies or in news articles, so the reliability of this should be questioned. Lastly, details for the cost of many systems were not publicly available.
The environmental impact of robotic surgery is another important consideration. A systematic review [107] reported that robotics compared to laparoscopy had 43.5% greater greenhouse gas emissions and 24% higher waste production. Many, but not all, of the robotic systems highlighted have reusable instruments (Table 1) which will undoubtedly help to offset this. Current and emerging robotic companies should take the environmental impact of their product into account, especially for future generations of robot. This should extend beyond the procedure itself, into a more holistic approach of the perioperative pathway.
This study has a number of limitations. Firstly, although we have carried out a comprehensive search through various channels, there is a chance we may have missed emerging platforms. Evaluation is also a dynamic process and requires regular updates to provide a true account of platforms’ status.
Challenges were observed in performing a comprehensive search strategy to identify new systems, including a lack of visibility for some. Reports were occasionally not found despite being mentioned on a company’s website, making it difficult to ascertain the stage of evaluation. We had to utilise multiple resources including a literature and Google search, screening old reviews, technology articles and reaching out multiple times to company emails. These efforts are not feasible outside the research setting and it is unrealistic to expect a practicing surgeon to investigate new devices or platforms to this level of evaluation, in order to provide the user guidance.
The IDEAL Framework stage of evaluation has been awarded based on studies investigating only a limited number of operation types. There is an argument to evaluate and assign an IDEAL Framework stage for each operation type, as it would certainly differ. This topic deserves discussion and expert consensus on how to evaluate new surgical technologies and/or how the IDEAL Framework should be implemented.
It has also been argued that the framework is not optimally suited for the evaluation of future robotic systems [16]. Despite this, it is likely the best framework available which can be adapted to evaluate new technology, providing a standardised and quality-assured pathway. Importantly, the framework has been globally accepted to ensure the safe implementation of novel interventions.
Conclusion
The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.
Data availability
Data can be made available upon reasonable request to the corresponding author.
References
Carr BM, Lyon JA, Romeiser J, Talamini M, Shroyer ALW (2019) Laparoscopic versus open surgery: a systematic review evaluating Cochrane systematic reviews. Surg Endosc 33(6):1693–1709. https://doi.org/10.1007/s00464-018-6532-2
Khajeh E et al (2023) Outcomes of robot-assisted surgery in rectal cancer compared with open and laparoscopic surgery. Cancers. https://doi.org/10.3390/cancers15030839
Hopkins MB et al (2020) Comparing pathologic outcomes for robotic versus laparoscopic Surgery in rectal cancer resection: a propensity adjusted analysis of 7616 patients. Surg Endosc 34(6):2613–2622. https://doi.org/10.1007/s00464-019-07032-1
Markar SR, Karthikesalingam AP, Venkat-Ramen V, Kinross J, Ziprin P (2011) Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot Comput Assist Surg 7(4):393–400. https://doi.org/10.1002/rcs.414
Safiejko K et al (2022) Robotic-assisted vs standard laparoscopic surgery for rectal cancer resection: a systematic review and meta-analysis of 19,731 patients. Cancers. https://doi.org/10.3390/cancers14010180
Kamarajah SK et al (2020) Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis. Eur J Surg Oncol 46(1):6–14. https://doi.org/10.1016/j.ejso.2019.08.007
Gavriilidis P, Wheeler J, Spinelli A, de’Angelis N, Simopoulos C, Di Saverio S (2020) Robotic vs laparoscopic total mesorectal excision for rectal cancers: has a paradigm change occurred? A systematic review by updated meta-analysis. Colorectal Dis 22(11):1506–1517. https://doi.org/10.1111/codi.15084
Solaini L, Cavaliere D, Avanzolini A, Rocco G, Ercolani G (2022) Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis. J Robot Surg 16(4):775–781. https://doi.org/10.1007/s11701-021-01312-6
Han C et al (2018) Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis. Surg Endosc 32(11):4377–4392. https://doi.org/10.1007/s00464-018-6295-9
Strategic Market Research (2022) Surgical robots market by application (orthopaedics, neurology, gynaecology, general surgery, others), end-user (hospitals, ambulatory surgical centres, others), by geography, segment revenue estimation, forecast, 2021-2030. https://www.strategicmarketresearch.com/market-report/surgical-robots-market. Accessed 13 Apr 2023
Sheetz KH, Claflin J, Dimick JB (2020) Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 3(1):8911. https://doi.org/10.1001/jamanetworkopen.2019.18911
Fortune Business Insights (2021) Robotic surgical procedures market size, share & COVID-19 impact analysis, by application (general surgery, gynecology, urology, orthopedics, and others), regional forecast, 2020-2027. https://www.fortunebusinessinsights.com/industry-reports/robotic-surgical-procedures-market-100124. Accessed 13 Apr 2023.
Vanlander AE et al (2020) ‘Orsi Consensus Meeting on European Robotic Training (OCERT): results from the first multispecialty consensus meeting on training in robot-assisted surgery. Eur Urol 78(5):713–716. https://doi.org/10.1016/j.eururo.2020.02.003
Alemzadeh H, Raman J, Leveson N, Kalbarczyk Z, Iyer RK (2016) Adverse events in robotic surgery: a retrospective study of 14 years of fda data. PLoS ONE. https://doi.org/10.1371/journal.pone.0151470
IDEAL Collaboration (2021) The IDEAL framework. IDEAL Collaboration. https://www.ideal-collaboration.net/the-ideal-framework/. Accessed 13 Apr 2023
Intuitive (2022) Intuitive annual report 2022
Liatsikos E, Tsaturyan A, Kyriazis I, Kallidonis P, Manolopoulos D, Magoutas A (2022) Market potentials of robotic systems in medical science: analysis of the Avatera robotic system. World J Urol 40:283–289. https://doi.org/10.1007/s00345-021-03809-z
Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A (2018) Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 122(3):501–519. https://doi.org/10.1111/bju.14219
Kinross JM, Mason SE, Mylonas G, Darzi A (2020) Next-generation robotics in gastrointestinal surgery. Nat Rev Gastroenterol Hepatol 17(7):430–440. https://doi.org/10.1038/s41575-020-0290-z
Moschovas MC et al (2021) Applications of the da Vinci single port (SP) robotic platform in urology: a systematic literature review. Minerva Urol Nephrol 73(1):6–16. https://doi.org/10.23736/S2724-6051.20.03899-0
Fahmy O, Fahmy UA, Alhakamy NA, Khairul-Asri MG (2021) Single-port versus multiple-port robot-assisted radical prostatectomy: A systematic review and meta-analysis. J Clinical Med. https://doi.org/10.3390/jcm10245723
Li K et al (2022) Perioperative and oncologic outcomes of single-port vs multiport robot-assisted radical prostatectomy: a meta-analysis. J Endourol 36(1):83–98. https://doi.org/10.1089/end.2021.0210
Suh I, Mukherjee M, Oleynikov D, Siu KC (2011) Training program for fundamental surgical skill in robotic laparoscopic surgery. Int J Med Robot Comput Assist Surg 7(3):327–333. https://doi.org/10.1002/rcs.402
Cowan A et al (2021) Virtual reality vs dry laboratory models: comparing automated performance metrics and cognitive workload during robotic simulation training. J Endourol 35(10):1571–1576. https://doi.org/10.1089/end.2020.1037
Oh PJ, Chen J, Hatcher D, Djaladat H, Hung AJ (2018) Crowdsourced versus expert evaluations of the vesico-urethral anastomosis in the robotic radical prostatectomy: is one superior at discriminating differences in automated performance metrics? J Robot Surg 12(4):705–711. https://doi.org/10.1007/s11701-018-0814-5
Hung AJ et al (2018) Utilizing machine learning and automated performance metrics to evaluate robot-assisted radical prostatectomy performance and predict outcomes. J Endourol 32(5):438–444. https://doi.org/10.1089/end.2018.0035
Nguyen JH et al (2020) Using objective robotic automated performance metrics and task-evoked pupillary response to distinguish surgeon expertise. World J Urol. https://doi.org/10.1007/s00345-019-02881-w
Hung AJ et al (2019) Experts vs super-experts: differences in automated performance metrics and clinical outcomes for robot-assisted radical prostatectomy. BJU Int 123(5):861–868. https://doi.org/10.1111/bju.14599
Ghodoussipour S, Reddy SS, Ma R, Huang D, Nguyen J, Hung AJ (2021) An objective assessment of performance during robotic partial nephrectomy: validation and correlation of automated performance metrics with intraoperative outcomes. J Urol 205(5):1294–1302. https://doi.org/10.1097/JU.0000000000001557
Chen J et al (2019) Effect of surgeon experience and bony pelvic dimensions on surgical performance and patient outcomes in robot-assisted radical prostatectomy. BJU Int 124(5):828–835. https://doi.org/10.1111/bju.14857
Hung AJ et al (2019) A deep-learning model using automated performance metrics and clinical features to predict urinary continence recovery after robot-assisted radical prostatectomy. BJU Int 124(3):487–495. https://doi.org/10.1111/bju.14735
Hung AJ, Ma R, Cen S, Nguyen JH, Lei X, Wagner C (2021) Surgeon automated performance metrics as predictors of early urinary continence recovery after robotic radical prostatectomy—a prospective bi-institutional study. Eur Urol Open Sci 27:65–72. https://doi.org/10.1016/j.euros.2021.03.005
Dai X et al (2021) Comparison of KD-SR-01 robotic partial nephrectomy and 3D-laparoscopic partial nephrectomy from an operative and ergonomic perspective: a prospective randomized controlled study in porcine models. Int J Med Robot Comput Assist Surg. https://doi.org/10.1002/rcs.2187
Li Z et al (2023) Robot-assisted modified bilateral dismembered V-shaped flap pyeloplasty for ureteropelvic junction obstruction in horseshoe kidney using KangDuo-surgical-robot-01 system. Int Braz J Urol. https://doi.org/10.1590/S1677-5538.IBJU.2022.0525
Wang J et al (2022) Partial nephrectomy through retroperitoneal approach with a new surgical robot system, KD-SR-01. Int J Med Robot Comput Assist Surg. https://doi.org/10.1002/rcs.2352
Xu W et al (2022) Robot-Assisted Partial Nephrectomy with a New Robotic Surgical System: Feasibility and Perioperative Outcomes. J Endourol 36(11):1436–1443. https://doi.org/10.1089/end.2022.0140
Fan S et al (2021) Robot-assisted pyeloplasty using a new robotic system, the KangDuo-Surgical Robot-01: a prospective, single-centre, single-arm clinical study. BJU Int 128(2):162–165. https://doi.org/10.1111/bju.15396
Fan S et al (2022) ‘Robot-assisted radical prostatectomy using the KangDuo surgical robot-01 system: a prospective, single-center, single-arm clinical study. J Urol 208(1):119–127. https://doi.org/10.1097/JU.0000000000002498
Dong J et al (2023) Feasibility, safety and effectiveness of robot-assisted retroperitoneal partial adrenalectomy with a new robotic surgical system: a prospective clinical study. Front Surg. https://doi.org/10.3389/fsurg.2023.1071321
Fan S et al (2022) Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results. J Endourol 36(12):1538–1544. https://doi.org/10.1089/end.2022.0366
Fan S et al (2023) Robot-assisted laparoscopic radical prostatectomy using the KangDuo surgical robot system versus the da Vinci Si robotic system. J Endourol. https://doi.org/10.1089/end.2022.0739
Li X et al (2023) Robot-assisted partial nephrectomy with the newly developed KangDuo surgical robot versus the da vinci si surgical system: a double-center prospective randomized controlled noninferiority trial. Eur Urol Focus 9(1):133–140. https://doi.org/10.1016/J.EUF.2022.07.008
Fanfani F et al (2016) The new robotic TELELAP ALF-X in gynecological surgery: single-center experience. Surg Endosc 30(1):215–221. https://doi.org/10.1007/s00464-015-4187-9
Coussons H, Feldstein J, McCarus S (2021) Senhance surgical system in benign hysterectomy: A real-world comparative assessment of case times and instrument costs versus da Vinci robotics and laparoscopic-assisted vaginal hysterectomy procedures. Int J Med Robot 17(4):2261. https://doi.org/10.1002/rcs.2261
Stephan D, Darwich I, Willeke F (2021) The TransEnterix European Patient Registry for robotic-assisted laparoscopic procedures in urology, abdominal, thoracic, and gynecologic surgery (“TRUST”). Surg Technol Int 38:103–107. https://doi.org/10.52198/21.STI.38.GS1394
Fujita Health University Press Release (2022) The world’s first gastric cancer resection surgery using the domestic surgery support robot “hinotoriTM” was performed. https://www.fujita-hu.ac.jp/news/j93sdv000000gkbp.html. Accessed 06 Apr 2023.
Sapporo Medical University (2022) We performed the world’s first surgery for colorectal cancer using the hinotoriTM Surgical Robot System, a domestically produced surgical support robot. https://web.sapmed.ac.jp/jp/news/press/qr68fj00000019f9.html. Accessed 06 Apr 2023
Kagoshima University Hospital (2022) The world’s first “Hinotori” surgery was performed at the gynecology department!. https://www.hosp.kagoshima-u.ac.jp/newskadai/20230120/. Accessed 06 Apr 2023
Takahashi Y et al (2022) Verification of delay time and image compression thresholds for telesurgery. Asian J Endosc Surg. https://doi.org/10.1111/ases.13150
Miyake H et al (2023) Initial experience of robot-assisted partial nephrectomy using hinotori surgical robot system: single institutional prospective assessment of perioperative outcomes in 30 cases. J Endourol. https://doi.org/10.1089/end.2022.0775
Hinata N et al (2022) Hinotori Surgical Robot System, a novel robot-assisted surgical platform: preclinical and clinical evaluation. Int J Urol 29(10):1213–1220. https://doi.org/10.1111/iju.14973
Medtronic (2023) Medtronic press releases. https://news.medtronic.com/Robotic-Assisted-Surgery-Technologies. Accessed 07 Apr 2023
Pietro Bianchi P, Salaj A, Rocco B, Formisano G (2023) First worldwide report on Hugo RASTM surgical platform in right and left colectomy. Updates Surg. https://doi.org/10.1007/s13304-023-01489-5
Quijano Y, Vicente E, Ferri V, Naldini C, Pizzuti G, Caruso R (2023) Robot-assisted Nissen fundoplication with the new HUGOTM Robotic assisted system: first worldwide report with system description, docking settings and video. Int J Surg Case Rep 106:108178. https://doi.org/10.1016/j.ijscr.2023.108178
Pietro Bianchi P, Salaj A, Rocco B, Formisano G (2023) First worldwide report on Hugo RASTM surgical platform in right and left colectomy. Updates Surg 75(3):775–780. https://doi.org/10.1007/s13304-023-01489-5
Gallioli A et al (2023) Initial experience of robot-assisted partial nephrectomy with HugoTM RAS system: implications for surgical setting. World J Urol 41(4):1085–1091. https://doi.org/10.1007/s00345-023-04336-9
Elorrieta V, Villena J, Kompatzki Á, Velasco A, Salvadó JA (2023) ROBOT assisted laparoscopic surgeries for nononcological urologic disease: initial experience with Hugo Ras system. Urology 174:118–125. https://doi.org/10.1016/j.urology.2023.01.042
Bravi CA et al (2023) ‘Outcomes of robot-assisted radical prostatectomy with the Hugo RAS surgical system: initial experience at a high-volume robotic center. Eur Urol Focus. https://doi.org/10.1016/j.euf.2023.01.008
Panico G et al (2023) The first 60 cases of robotic sacrocolpopexy with the novel HUGO RAS system: feasibility, setting and perioperative outcomes. Front Surg 10:1181824. https://doi.org/10.3389/fsurg.2023.1181824
HKEXnews (2023) Edge medical overview by hkexnews. https://www1.hkexnews.hk/app/sehk/2023/105063/a115209/sehk23011100849.pdf. Accessed 08 Apr 2023
Yang X et al (2022) Application of 5G technology to conduct tele-surgical robot-assisted laparoscopic radical cystectomy. Int J Med Robot Comput Assist Surg. https://doi.org/10.1002/rcs.2412
Zeng Y, Wang G, Liu Y, Li Z, Yi B, Zhu S (2020) The “Micro Hand S” robot-assisted versus conventional laparoscopic right colectomy: short-term outcomes at a single center. J Laparoendosc Adv Surg Tech A 30(4):363–368. https://doi.org/10.1089/lap.2019.0714
Luo D et al (2020) 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 34(8):3368–3374. https://doi.org/10.1007/s00464-019-07107-z
Liu Y et al (2022) Evaluation of effect of robotic versus laparoscopic surgical technology on genitourinary function after total mesorectal excision for rectal cancer. Int J Surg 104:106800. https://doi.org/10.1016/j.ijsu.2022.106800
Li W et al (2021) Robot-assisted sleeve gastrectomy in patients with obesity with a novel Chinese domestic MicroHand SII surgical system. BMC Surg 21(1):260. https://doi.org/10.1186/s12893-021-01259-3
Lim JH, Lee WJ, Choi SH, Kang CM (2021) Cholecystectomy using the Revo-i robotic surgical system from Korea: the first clinical study. Updates Surg 73(3):1029–1035. https://doi.org/10.1007/s13304-020-00877-5
Ku G, Kang I, Lee WJ, Kang CM (2020) Revo-i assisted robotic central pancreatectomy. Ann Hepatobiliary Pancreat Surg 24(4):547–550. https://doi.org/10.14701/ahbps.2020.24.4.547
Chang KD, Abdel Raheem A, Choi YD, Chung BH, Rha KH (2018) Retzius-sparing robot-assisted radical prostatectomy using the Revo-i robotic surgical system: surgical technique and results of the first human trial. BJU Int 122(3):441–448. https://doi.org/10.1111/bju.14245
Alip S, Koukourikis P, Han WK, Rha KH, Na JC (2022) Comparing Revo-i and da Vinci in Retzius-sparing robot-assisted radical prostatectomy: a preliminary propensity score analysis of outcomes. J Endourol 36(1):104–110. https://doi.org/10.1089/end.2021.0421
MedBot (2023) MedBot 2022 annual presentation. MedBot. https://ir.medbotsurgical.com/media/g3ohjiy4/medbot_2022-annual-presentation.pdf. Accessed 12 Apr 2023
MicroPort (2022) MicroPort® MedBotTM announces 2022 interim results. https://microport.com/news/microport-medbot-announces-2022-interim-results. Accessed 12 Apr 2023
Kelkar D, Borse MA, Godbole GP, Kurlekar U, Slack M (2021) 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 35(9):5193–5202. https://doi.org/10.1007/s00464-020-08014-4
Collins D, Paterson HM, Skipworth RJE, Speake D (2021) Implementation of the Versius robotic surgical system for colorectal cancer surgery: first clinical experience. Colorectal Dis 23(5):1233–1238. https://doi.org/10.1111/codi.15568
Si E (2023) Charged by surgical robot’s approval, Shenzhen Edge Medical makes new IPO bid. Bamboo Works. https://thebambooworks.com/charged-by-surgical-robots-approval-shenzhen-edge-medical-makes-new-ipo-bid/. Accessed 08 Apr 2023
Crowe S (2021) Edge Medical Robotics raises $92M series B. The Robot Report. https://www.therobotreport.com/edge-medical-robotics-raises-92m-surgical-robots/. Accessed 08 Apr 2023
Pandaily (2021) Edge Medical Robotics completes C-round financing exceeding $200 million from Boyu Capital and others. Pandaily. https://pandaily.com/edge-medical-robotics-completes-c-round-financing-exceeding-200-million-from-boyu-capital-and-others/. Accessed 08 Apr 2023
Liu C et al (2020) Robot-assisted nephrectomy using the newly developed EDGE SP1000 single-port robotic surgical system: a feasibility study in porcine model. J Endourol 34(11):1149–1154. https://doi.org/10.1089/end.2020.0208
Kang L et al (2021) First preclinical experience with the newly developed EDGE SP1000 single-port robotic surgical system-assisted transanal total mesorectal excision. Gastroenterol Rep (Oxf) 9(6):603–605. https://doi.org/10.1093/gastro/goab039
MAPSCapital by Mirae Asset (2022) Edge Medical completes the first single-port gynecologic clinical trial in China. MAPSCapital by Mirae Asset
Böhlen D, Gerber R (2023) First ever radical prostatectomy performed with the new dexter robotic system™. Eur Urol. https://doi.org/10.1016/j.eururo.2023.02.004
Forgues A et al (2022) 3D partial nephrectomy with Dexter surgical robot. Eur Urol Open Sci 44:S403. https://doi.org/10.1016/s2666-1683(22)02251-0
Robin H et al (2022) Robot-assisted promontofixation and annexectomy for pelvic organe prolapse: initial experience with the Dexter system. Eur Urol Open Sci 44:S346. https://doi.org/10.1016/s2666-1683(22)02194-2
Mignot H, Riff Y, Pitre J, Durand-Dastes F, Capitaine J, Diack B (2023) Feasibility and safety of a new “on-demand robotics” platform for inguinal hernia repair. In: EHS 45th International Congress. https://stats.oecd.org
Cairns E (2019) Avatera Medical becomes the newest robotic surgery group in Europe. Evaluate Vantage. https://www.evaluate.com/vantage/articles/interviews/avatera-medical-becomes-newest-robotic-surgery-group-europe. Accessed 06 Apr 2023
Peteinaris A et al (2023) The feasibility of robot-assisted radical cystectomy: an experimental study. World J Urol 41(2):477–482. https://doi.org/10.1007/s00345-022-04266-y
Gkeka K et al (2023) Robot-assisted radical nephrectomy using the novel avatera robotic surgical system: a feasibility study in a porcine model. J Endourol 37(3):273–278. https://doi.org/10.1089/end.2022.0596
Lehman AC, Wood NA, Farritor S, Goede MR, Oleynikov D (2011) Dexterous miniature robot for advanced minimally invasive surgery. Surg Endosc 25(1):119–123. https://doi.org/10.1007/s00464-010-1143-6
Wortman TD, Mondry JM, Farritor SM, Oleynikov D (2013) Single-site colectomy with miniature in vivo robotic platform. IEEE Trans Biomed Eng 60(4):926–929. https://doi.org/10.1109/TBME.2012.2226884
Miao C (2021) The first domestic single-port surgical robot independently developed by the team led by Professor Xu Kai of Shanghai Jiaotong University completed the first pure single-port radical prostatectomy in China. Shanghai Jiao Tong University, Robotics Institute
Shurui, Surgerii.com (2023) Robotic surgery is on the rise. Shurui, Surgerii. Accessed 12 Apr 2023
Science Network (2022) The first domestic single-port robot successfully operated on sigmoid colon cancer. https://news.sciencenet.cn/htmlnews/2022/3/475538.shtm Accessed 12 Apr 2023
Chen Y (2021) Bleeding 10ml! The surgical robot removes the tumor in less than an hour. Yangtze Evening News. https://author.baidu.com/home?from=bjh_article&app_id=1703501714527514. Accessed 12 Apr 2023
RobSurgical (2023) Bitrack system. RobSurgical. https://www.robsurgical.com/. Accessed 12 Apr 2023
Ronovo Surgical (2023) Ronovo wins resounding KOL accolades in latest CarinaTM RAS Platform animal labs
Titan Medical (2022) De Novo marketing authorization planned for early 2025 remains unchanged. https://ir.titanmedicalinc.com/news-events/press-releases/detail/360/titan-medical-provides-update-to-enos-project-timeline. Accessed 12 Apr 2023
Titan Medical (2022) Titan to support Medtronic development and pre-clinical activities through supply of instruments and cameras. https://ir.titanmedicalinc.com/news-events/press-releases/detail/366/titan-medical-signs-definitive-agreement-with-medtronic. Accessed 12 Apr 2023
Seeliger B, Diana M, Ruurda JP, Konstantinidis KM, Marescaux J, Swanström LL (2019) Enabling single-site laparoscopy: the SPORT platform. Surg Endosc 33(11):3696–3703. https://doi.org/10.1007/s00464-018-06658-x
Cairns E (2021) Supply chain crunch hits robotics. Evaluate Vantage. https://www.evaluate.com/vantage/articles/news/snippets/supply-chain-crunch-hits-robotics. Accessed 12 Apr 2023
DLR (2021) Surgical robot with DLR technology on the market. Deuteches Zentrum fur Luft- und Raumfahrt
Vicarious Surgical (2023) Vicarious surgical. https://www.vicarioussurgical.com/. Accessed 13 Apr 2023
Intuitive Surgical Inc. (2023) da Vinci 4th generation robotic systems. https://www.intuitive.com/en-us/products-and-services/da-vinci/systems/sp. Accessed 13 Apr 2023
Kawasaki Technical Review (2022) hinotori surgical robot system, the first made-in-Japan robotic-assisted surgery system
reddot (2022) WEGO MicroHand S surgical robot system. https://www.red-dot.org/project/wego-microhand-s-surgical-robot-system-58348. Accessed 19 Apr 2023
SURGROB (2020) The richest surgical robotics spinoff - MicroPort’s medrob, SURGROB. http://surgrob.blogspot.com/2020/09/the-richest-surgical-robotics-spinoff.html. Accessed 03 Jun 2023
CMR Surgical (2023) Press kit. CMRsurgical.com. https://cmrsurgical.com/press-kit. Accessed 19 Apr 2023
Taylor A (2020) Robots at work and play. The Atlantic, February 6 2020. www.theatlantic.com/photo/2020/02/photos-robots-work-and-play/606196/#img25
Environmental sustainability in robotic and laparoscopic surgery (2022) systematic review. Br J Surg 109:921–932. https://doi.org/10.1093/bjs/znac191
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We would like to acknowledge the collaboration of robotic companies who helped make this article possible.
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Matthew Boal’s PhD research is funded by Digital Surgery Ltd., a Medtronic company, however, remains independent from the research on this study, only collaborating with details of the Hugo™ RAS System, Medtronic. All other authors including Costanza Giovene Di Girasole, Freweini Tesfai, Tamsin Morrison, Simon Higgs, Jawad Ahmad, Alberto Arezzo and Nader Francis have no disclosures.
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Boal, M., Di Girasole, C.G., Tesfai, F. et al. Evaluation status of current and emerging minimally invasive robotic surgical platforms. Surg Endosc 38, 554–585 (2024). https://doi.org/10.1007/s00464-023-10554-4
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DOI: https://doi.org/10.1007/s00464-023-10554-4