Establishment of a new practical telesurgical platform using the hinotori™ Surgical Robot System: a preclinical study

Abstract

Aim: The recent development of new surgical robots and network telecommunication technology has opened new avenues for robotic telesurgery. Although a few gastroenterological surgeries have been performed in the telesurgery setting, more technically demanding procedures including gastrectomy with D2 lymphadenectomy and intracorporeal anastomosis have never been reported. We examined the feasibility of telesurgical robotic gastrectomy using the hinotori™ Surgical Robot System in a preclinical setting.

Methods: First, the suturing time in the dry model was measured in the virtual telesurgery setting to determine the latency time threshold. Second, a surgeon cockpit and a patient unit were installed at Okazaki Medical Center and Fujita Health University, respectively (approximately 30 km apart), and connected using a 10-Gbps leased optic-fiber network. After evaluating the feasibility in the dry gastrectomy model, robotic distal gastrectomies with D2 lymphadenectomy and intracorporeal B-I anastomosis were performed in two porcine models.

Results: The virtual telesurgery study identified a latency time threshold of 125 ms. In the actual telesurgery setting, the latency time was 27 ms, including a 2-ms telecommunication network delay and a 25-ms local information process delay. After verifying the feasibility of the operative procedures using a gastrectomy model, two telesurgical gastrectomies were successfully completed without any unexpected events. No fluctuation was observed across the actual telesurgeries.

Conclusion: Short-distance telesurgical robotic surgery for technically more demanding procedure may be safely conducted using the hinotori Surgical Robot System connected by high-speed optic-fiber communication.

Keywords: Gastrectomy; Lymphadenectomy; Remote operations; Robotic surgical procedure.

Fig. 1

The hinotori Surgical Robot System. A surgical cockpit (a), an operation unit (b), four manipulating arms with eight axes without attaching the trocar (c, d)

Fig. 2

The network map in the virtual telesurgical setting and actual telesurgical gastrectomy setting in porcine models. In the virtual setting, the delay generator was inserted between the network switches

Fig. 3

Suturing under the virtual telesurgery setting (a) and questionnaires after suturing in the virtual setting (b)

Fig. 4

The real-time three-dimensional illustration of the robotic arms (a), telesurgical gastrectomy using a gastrectomy model (b), and the operating surgeon (c) and the surgical robot (d) during telesurgical gastrectomy in a porcine model

Fig. 5

The suturing time (a) and surgeons’ answers (b–d) under each virtual delay setting

Fig. 6

D2 nodal dissection in the telesurgical gastrectomy in a porcine model. Division of the left gastroepipoloic artery (LGEA) (a), division of the left gastroepipoloic vein (RGEV) (b), dissection at the suprapancreatic area and left gastric vein (LGV) (c), division of the left gastric artery (d), nodal dissection along the proper hepatic artery (PHA) and portal vein (PV) (e), and dissection along the right gastric artery (RGA) (f). CHA, common hepatic artery; PV, portal vein; PHA, proper hepatic artery; LHA, left hepatic artery

Fig. 7

Intracorporeal Billroth-I anastomosis using linear staplers (a–d)