EDGE SP1000 Robotic System-Assisted Transumbilical Laparoendoscopic Single-Site Radical Hysterectomy Plus Sentinel Lymph Node Biopsy

Abstract

Introduction:

Compared with traditional laparotomy and multiport laparoscopic surgery (MPLS), laparoscopic single site surgery (LESS) has the advantages of minimal trauma, light pain, aesthetic effect, and fast recovery, but its application was limited due to loss of triangulation, poor visualization, limited movement, and a long learning curve. Robotic surgery, which made a compensation for LESS owing to its improved visualization, dexterity, and optimized ergonomics, has gained widespread attention in gynecology. Robotic LESS has been proved to be safe with da Vinci Si/Xi, which were initially designed for MPLS, when performing LESS, the arm space is relatively restricted and external clashing of the robotic arms increased. The da Vinci SP system was introduced to solve the technical challenges, existing literatures have proved its feasibility in benign gynecological diseases, but very few studies concerning malignant tumors. ^1–2 Recently, a new single-arm robotic system (EDGE SP1000, Shenzhen Jingfeng Medical Technology Co., Ltd., Shenzhen, China) was developed, a preclinical trial in porcine model has preliminarily confirmed its safety. ³

Materials and Methods:

The EDGE SP1000 system contains a single robot arm that controls a fully wristed, high‐resolution 3D camera and up to 3 snake‐like, flexible instruments, which are able to be inserted into the abdominal cavity through a single-site robotic trocar simultaneously (Fig. 1). In a single-arm clinical trial, 18 patients with 8 malignant gynecological tumors underwent surgery successfully via EDGE SP1000; the total operative time was 190.1 ± 83.3 min for benign diseases and 254.4 ± 59.4 min for malignant diseases; no perioperative complications occurred. ⁴ A radical surgery of cervical cancer was concluded in this clinical trial; in this case, a 53-year-old postmenopausal woman who presented with postcoital bleeding for 5 months was diagnosed with cervical cancer of stage IB1 (International Federation of Gynecology and Obstetrics, 2018). The pathological results of cervical biopsy revealed papillary adenocarcinoma. Nanocarbon was used to perform sentinel lymph node tracing because the indocyanine green (ICG) imaging system was not incorporated with EDGE SP1000.

FIG. 1.

Port placement using the EGDE SP1000 robotic surgical system.

Results:

A complete procedure of type C radical hysterectomy with bilateral salpingo-oophorectomy plus sentinel lymph node biopsy was performed via this new surgical system without any complications. The operation time was 307 minutes, estimated blood loss was 50 mL, the patient discharged on the 5th days of surgery. The umbilical incision was closed by Zheng’s anchor suturing technique. ⁵ Final pathological reveals well-differentiated cervical papillary adenocarcinoma without stromal invasion, no sentinel lymph nodes invasion (0/5) and negative for corpus uteri, ovaries, parametrium or margins. The patient was followed up for 28 months without any evidence of recurrence or complications.

Conclusions:

As is shown in the video, the one-armed robot avoided the external arm collisions, and three multi-jointed, snake-shaped instruments increased the operating freedom and flexibility, restored the operative triangulation, and therefore, the incidence of instruments collisions and interferences reduced. Besides, up to three surgical instruments were independently controlled by one surgeon to expose the surgical field sufficiently during surgery (Fig. 2), which reduced the dependency of the surgical assistant. In conclusion, the EDGE SP1000 robotic surgical system is technically feasible and safe in such a complex single-site gynecological procedure.

FIG. 2.

Sufficient exposure of surgical space.

This work was supported by The National Key R&D Program of China (grant number 2022YFC2704103).

All authors report that they have no financial or personal relationships to disclose

.

Patient consent statement:

The patient has provided a written consent.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

This work was approved by the Institutional Review Borad of West China Second University Hopsital. (Number: Q20211007).

Runtime of video:

9 mins 58 secs.