ArtiSential® Clip Applier Use in Robotic Urologic Surgery: Initial Experience and Outcomes

Objective: The ArtiSential® clip applier (LivsMed®, San Diego, CA, USA) is a new double-jointed laparoscopic clip applier with 90° wrist articulation. We sought to explore the feasibility of the new clip applier in robotic urologic surgery and compare it with the standard Weck® laparoscopic Hem-o-lok® clip applier. Materials and Methods: A retrospective review of 100 consecutive robotic urologic surgeries completed using the new clip applier by two surgeons was conducted from August 2024 to January 2025. The surgeries performed were robotic radical prostatectomy (RALP), robotic radical nephrectomy (RARN), and robotic partial nephrectomy (RAPN). Clips were applied during pelvic lymph node dissection in RALP, during ureteral transection in RARN, and during renorrhaphy in RAPN. Both ArtiSential (Group 1) and Hem-o-lok (Group 2) clips were applied during similar portions of the cases, with the latter group acting as a control. The number of successfully deployed clips (no misfires) was recorded and compared between groups. Subjective surgeon and bedside assistant approval was assessed using a dichotomous scale of yes/no for correct clip application. Cognitive load for the bedside assistant using the ArtiSential clip applier was measured using the NASA task load index (TLX). Results: A total of 340 clips in Group 1 and 360 clips in Group 2 were used. The percent of successful deployments of clips in Group 1 was 97.1% (330/340), while in Group 2 it was 94.4% (340/360) (p < 0.05). Subjective bedside assistant assessment of clip application was 91.2% accuracy in Group 1 (301/330 clips) and 87.6% accuracy in Group 2 (298/340 clips). Subjective surgeon assessment of clip application was 89.1% in Group 1 (294/330 clips) and 83.2% in Group 2 (283/340 clips). The mean NASA-TLX was significantly higher in Group 1 compared with Group 2. There was one reported lymphocele in Group 2. Conclusions: The ArtiSential clip applier is a double-jointed, multi-articulating laparoscopic clip applier that allows for improved accuracy of clip application when compared to standard Weck Hem-o-lok clip appliers in pelvic and retroperitoneal robotic urologic surgery.