A prospective analysis of robotic tip cover accessory failure

Area of Science:

• Urology
• Gynecology
• Surgical Technology
• Biomedical Engineering

Background:

• Robotic monopolar scissors utilize tip cover accessories (TCAs) for insulation.
• Reports of insulation failure and patient injury associated with TCAs necessitate systematic study.
• The incidence and mechanisms of TCA malfunction require investigation.

Purpose of the Study:

• To investigate the incidence of TCA failure.
• To identify potential mechanisms leading to TCA malfunction.
• To compare the failure rates of first-generation (f-TCAs) and second-generation (s-TCAs).

Main Methods:

• Eighty TCAs (40 f-TCAs, 40 s-TCAs) were collected post-surgery.
• Microscopic inspection assessed insulation defects.
• Current leak and electrical arcing were tested using electrolysis solution and a porcine kidney model, respectively.
• Statistical analyses (log-rank, Friedman, chi-square) compared failure rates under varying conditions and between generations.

Main Results:

• 39% of f-TCAs exhibited visible insulation defects.
• Electrical arcing occurred in 33% of f-TCAs, increasing with angulation and power.
• No electrical arcing was observed in any s-TCAs.
• s-TCAs showed significantly lower failure rates compared to f-TCAs (P<0.001).

Conclusions:

• First-generation TCAs demonstrate a substantial insulation failure rate (33%) after single use.
• TCA failure is exacerbated by increased wrist angulation and electrical power settings.
• The improved second-generation TCA design significantly reduces failure potential, showing no arcing in ex-vivo testing.