Flexible suction-coagulation probe restores dexterity in robot-assisted surgery: bench-to-bedside evaluation

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Medical Device Engineering

Background:

• Rigid suction-coagulation probes limit the articulation essential for robotic surgery.
• A modified core design in a new flexible suction-coagulation probe (flex-SBC) aims to restore this lost dexterity.
• This study assesses the mechanical properties and clinical feasibility of the flex-SBC.

Purpose of the Study:

• To design and evaluate a 5-mm single-use flexible suction ball coagulator (flex-SBC) to improve robotic surgery dexterity.
• To assess the flex-SBC's mechanical performance, including pliability and suction flow.
• To evaluate the early clinical feasibility and the impact of gripping strategies on suction flow.

Main Methods:

• Preclinical mechanical testing compared a 7x7 core flex-SBC with a conventional 1x7 core design for shaft pliability (sagging displacement, rebound force).
• Suction flow rates at varying pressures (-20, -30, -40 kPa) were measured.
• The flex-SBC was used in 12 robotic gastrectomies, collecting data on device performance, adverse events, and surgeon feedback.

Main Results:

• The 7x7 core significantly increased pliability (sagging displacement) and reduced rebound force compared to the 1x7 core (p < 0.001).
• Suction flow rates met established thresholds for effective evacuation, though approximately half that of rigid probes (p < 0.001).
• Gripping the silicone shaft, particularly with Maryland forceps, reduced flow by 60% (p < 0.001).

Conclusions:

• The flex-SBC demonstrates safe and practical utility in robot-assisted upper-GI surgery, bending with the robotic instruments.
• Surgeon training on grip technique is crucial, as it significantly impacts device performance.
• Further comparative trials are needed to determine if ergonomic benefits translate to improved operative times and oncologic outcomes.