Cross-platform integration of robotic intraoperative ultrasound using system-agnostic drop-in probes: technical...

Intraoperative ultrasound can enhance real-time image guidance in minimally invasive surgery, but its integration into robotic workflows remains heterogeneous and frequently platform dependent. This study aimed to evaluate the feasibility and reproducibility of a standardized robotic intraoperative ultrasound (RIOUS) workflow using two system-agnostic drop-in probes across four multi-port robotic platforms and to generate video-based reference material for cross-platform training. A technical feasibility study was conducted at IRCAD (Strasbourg, France) using the ARIETTA750VE ultrasound system, two drop-in linear probes (L43K and L51K), and an abdominal ultrasound phantom housed in a box trainer. Four robotic platforms were assessed: da Vinci Xi, Hugo RAS, Toumai, and hinotori. A standardized six-step protocol evaluated ultrasound machine positioning, safety checks, trocar configuration, probe insertion through an additional 12-mm surgical trocar, console image display, grasper selection and corresponding probes manipulation. The standardized workflow was successfully completed on all four platforms. Both probes were inserted and manipulated intracorporeally without probe detachment, cable entanglement or robotic arm interference. Real-time B-mode imaging was displayed at the console on every system through native split-view or picture-in-picture functions, or through an external auxiliary-display. Platform-specific differences were observed in room layout, visualization modality and preferred grasper selection, but stable handling was achieved with standard robotic instruments on all systems. No relevant difference in clip grip stability between the two probe models was observed. A reproducible, platform-agnostic RIOUS workflow is feasible across four architecturally distinct robotic systems. System-agnostic drop-in probes may facilitate cross-platform skill transfer, support structured training and represent a practical step toward collaborative tele-image-guided robotic surgery.