Initial experience with the MIZZO ENDO 4000 robotic surgical system: a prospective, single-center, multi-specialty...

Robotic-assisted surgery is increasingly central to minimally invasive surgery, offering improved dexterity, three-dimensional visualization, and ergonomic advantages over conventional laparoscopy. The present study aimed to evaluate the feasibility, safety, and short-term performance of the MIZZO ENDO 4000 Advanced Surgical Robotic System (Merai Newage Pvt. Ltd.) in real-world clinical practice. In this prospective, single-arm, open-label, single-center study, 72 adults undergoing general surgical, gynecologic, urologic, or oncologic procedures amenable to a laparoscopic approach were enrolled at a tertiary care center in New Delhi, India, between January and June 2026. Primary endpoints were surgical success, postoperative complications (Clavien-Dindo), and intraoperative blood loss; secondary endpoints included console and operative time, docking time, length of stay, and surgeon-reported satisfaction. All 72 procedures were completed as planned, with no conversion to open or laparoscopic surgery (surgical success, 100%) and no intraoperative complications. Postoperative complications occurred in 6 participants (8.33%), all Clavien-Dindo grade I (low-grade fever or nausea/vomiting), managed with routine supportive care. Mean intraoperative blood loss was 79.46 ± 61.25 mL, mean console time 1.86 ± 1.49 h, and mean total operative time 3.49 ± 1.74 h. Mean length of hospital stay was 5.64 ± 3.78 days. Operating surgeons rated the platform favorably across all nine satisfaction domains, including reduced physical strain and fatigue relative to conventional laparoscopy. The MIZZO ENDO 4000 performed safely and as intended across a diverse real-world caseload, supporting its feasibility in routine clinical use. Larger, multi-center, and comparative studies are necessary to confirm these findings.