Tele-robot-assisted minimally invasive esophagectomy using a double-surgeon cockpit on a cadaver

We conducted this study to evaluate the efficacy of robot-assisted minimally invasive esophagectomy (RAMIE) on cadavers in the prone position, utilizing telesurgical support through the double-surgeon cockpit (double SC) of the novel Japanese-made surgical robot system, hinotori^™ (Medicaroid, Kobe, Japan). The Cadaveric Anatomy and Surgical Training Laboratory (CAST Lab) at Hokkaido University and Kushiro City General Hospital (KCGH) are interconnected by a dedicated 1 Gbps internet line, spanning 300 km. An operation unit and double SC were installed at CAST Lab, whereas the double SC proctor was installed at KCGH. RAMIE was performed with telesurgical support on two adult cadavers. The onsite and proctor operation times were recorded as 88/79 min and 64/75 min, respectively. Throughout the surgical procedures, communication remained stable, with an average communication delay of 13.1 ms (range: 11.0-15.0 ms). This study demonstrated the feasibility of performing RAMIE with the patient in the prone position, supported by telesurgical support using a double SC on the hinotori^™ platform.