Robotic infant surgery with 3 mm instruments: a study in piglets of less than 10 kg body weight.
Thomas F Krebs, Jan-Hendrik Egberts, Ulf Lorenzen, Martin F Krause, Katja Reischig, Roberts Meiksans, Jonas Baastrup, Andreas Meinzer, Ibrahim Alkatout, Gesa Cohrs, Henning Wieker, Annette Lüthje, Sarah Vieten, Gerhard Schultheiss, Robert Bergholz
Author Information
Thomas F Krebs: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Jan-Hendrik Egberts: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Ulf Lorenzen: Department of Anesthesia and Intensive Care Medicine, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Martin F Krause: Department of Pediatrics I and Pediatric Intensive Care Medicine, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Katja Reischig: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Roberts Meiksans: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Jonas Baastrup: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Andreas Meinzer: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Ibrahim Alkatout: Department of Obstetrics and Gynecology, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Gesa Cohrs: Department of Neurosurgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Henning Wieker: Department of Cranio-Maxillo-Facial Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Annette Lüthje: Department of Animal Welfare, CAU Kiel, Olshausenstr. 40, 24098, Kiel, Germany.
Sarah Vieten: Department of Animal Welfare, CAU Kiel, Olshausenstr. 40, 24098, Kiel, Germany.
Gerhard Schultheiss: Department of Animal Welfare, CAU Kiel, Olshausenstr. 40, 24098, Kiel, Germany.
Robert Bergholz: Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany. robert.bergholz@uksh.de. ORCID
No data exist concerning the appication of a new robotic system with 3 mm instruments (Senhance®, Transenterix) in infants and small children. Therefore, the aim of this study was to test the system for its feasibility, performance and safety of robotic pediatric abdominal and thoracic surgery in piglets simulating infants with a body weight lower than 10 kg. 34 procedures (from explorative laparoscopy to thoracoscopic esophageal repair) were performed in 12 piglets with a median age of 23 (interquartile range: 12-28) days and a median body weight of 6.9 (6.1-7.3) kg. The Senhance® robotic system was used with 3 mm instruments, a 10 mm 3D 0° or 30° videoscope and advanced energy devices, the setup consisted of the master console and three separate arms. The amount, size, and position of the applied ports, their distance as well as the distance between the three operator arms of the robot, external and internal collisions, and complications of the procedures were recorded and analyzed. We were able to perform all planned surgical procedures with 3 mm robotic instruments in piglets with a median body weight of less than 7 kg. We encountered two non-robot associated complications (bleeding from the inferior caval and hepatic vein) which led to termination of the live procedures. Technical limitations were the reaction time and speed of robotic camera movement with eye tracking, the excessive bending of the 3 mm instruments and intermittent need of re-calibration of the fulcrum point. Robotic newborn and infant surgery appears technically feasible with the Senhance® system. Software adjustments for camera movement and sensitivity of the fulcrum point calibration algorithm to adjust for the increased compliance of the abdominal wall of infants, therefore reducing the bending of the instruments, need to be implemented by the manufacturer as a result of our study. To further evaluate the Senhance® system, prospective trials comparing it to open, laparoscopic and other robotic systems are needed.
