Vas Guide: a novel device for looping blood vessels in robot-assisted surgery

Looping blood vessels in robot-assisted surgery remains challenging because of limitations in instrument articulation, joint length, and the lack of tactile feedback. To address this critical issue, we developed the Vas Guide, a novel device, for safe blood vessel handling. This study aims to establish the efficacy, safety, and durability of the Vas Guide.

The Vas Guide is a flat, curved stainless-steel strip with blunt, rounded ends and a hole near the distal end. After sufficient dissection of the posterior surface of the target blood vessel, the Vas Guide with a vessel loop tied to the distal end was passed around the blood vessel in a single step using a suturing-like motion, thereby enabling secure vessel management. It is reusable and has a unit price of approximately $600. We analyzed 83 patients undergoing robot-assisted partial nephrectomy or nephroureterectomy at Tokushima University Hospital: 39 in the Vas Guide group and 44 in the conventional group. Outcomes including looping time, looping-related complication rates, such as collisions between instruments and bleeding, and additional instrument usage were recorded. The National Aeronautics and Space Administration task load index (NASA-TLX) scores were assessed.

The patients' characteristics were comparable between the two groups. The Vas Guide group demonstrated significantly better outcomes, including faster looping times (31 vs. 90 s, p < 0.001), fewer looping-related complications (0% vs. 30%, p < 0.001), no additional instrument usage (0% vs. 50%, p < 0.001), and better NASA-TLX scores (26.5 vs. 75.7, p < 0.001). The Vas Guide showed no usability issues, with only minor surface scratches and a slight radius change (8.60 mm to 8.69 mm).

This reusable device combines high efficacy, safety, and durability and can be implemented at a relatively low cost.