Usability of an independent arm modular robotic system in abdominal wall surgery: supraumbilical midline closure

Background:

Minimally invasive surgery, including robotic approaches, has proven effective in repairing various types of abdominal wall hernia defects, ranging from simple to complex cases. The Versius Surgical System® (CMR Surgical, Cambridge, United Kingdom) was developed to optimize the surgical experience and improve patient outcomes.

Aims:

This study aims to evaluate system applicability and its positioning and configuration within the operating room, using a preclinical in vitro model for supraumbilical midline closure.

Methods:

The study was conducted at the Teaching and Research Laboratory of Universidade de São Paulo University Hospital, using an in vitro synthetic latex abdominal wall model. For supraumbilical midline closure, the instrument units were positioned laterally (right and left), near the hypochondria, and the visualization unit was placed on the right side at the level of the pelvis. Surgical access points were created to allow for continuous suturing of an approximately 10 cm incision: one 10 mm suprapubic trocar and two 5 mm trocars placed bilaterally along the anterior axillary line at the level of the umbilicus.

Results:

The initial positioning of the robotic units allowed for an ergonomic configuration suitable for suturing. The continuous supraumbilical suture was performed using 2-0 barbed non-absorbable suture material, two needle drivers, and laparoscopic scissors, with stitch intervals of approximately 1 cm and moderate tension. Adequate closure of the hernia defect was achieved. The in vitro laboratory training phase totaled 20 hours. During this period, continuous suture was performed five times, with completion times ranging from 45 to 25 minutes.

Conclusions:

The Versius Surgical System® demonstrated full operational capability for supraumbilical midline closure in an inanimate model, without complications. Strategic positioning of the robotic arms allowed for adequate access and satisfactory docking times. Mastering the spatial positioning of the units is essential for optimizing the operative field and reducing non-productive time.