Robotic-Assisted Surgery in Children Using the Senhance® Surgical System: An Observational Study

Abstract

Background: Robotic-assisted surgery (RAS) holds many theoretical advantages, especially in pediatric surgical procedures. However, most robotic systems are dedicated to adult surgery and are less suitable for smaller children. The Senhance^® Surgical System (SSS^®), providing 3 mm and 5 mm instruments, focuses on making RAS technically feasible for smaller children. This prospective observational study aims to assess whether RAS in pediatric patients using the SSS^® is safe and feasible.

Methods and results: A total of 42 children (aged 0-17 years, weight ≥ 10 kg) underwent a RAS procedure on the abdominal area using the SSS^® between 2020 and 2023. The study group consisted of 20 male and 22 female individuals. The mean age was 10.7 years (range 0.8 to 17.8 years), with a mean body weight of 40.7 kg (range 10.1 to 117.3 kg). The 3-mm-sized instruments of the SSS^® were used in 12 of the 42 children who underwent RAS. The RAS procedures were successfully completed in 90% of cases. The conversion rate to conventional laparoscopy was low (10%), and there were no conversions to open surgery. One of the 42 cases (2%) experienced intraoperative complications, whereas six children (14%) suffered from a postoperative complication. Overall, 86% of the patients had an uncomplicated postoperative course.

Conclusions: The results of the current observational study demonstrate the safety and feasibility of utilizing the SSS^® for abdominal pediatric RAS procedures. The study provides new fundamental information supporting the implementation of the SSS^® in clinical practice in pediatric surgery.

Keywords: Senhance Surgical System; children; minimally invasive surgery; pediatric patients; robotic-assisted laparoscopy; robotic-assisted surgery.

Figure 1

A 3 mm instrument from the Senhance Surgical System^®.

Figure 2

An example of the trocar positions during an inguinal hernia repair.

Figure 3

An example of the robotic arm positions during a robotic-assisted Nissen fundoplication.

Figure 4

Flow chart of participants’ enrollment, inclusion, and follow-up.

Figure 5

Boxplot of the docking times of the robot during the 42 robotic-assisted surgery (RAS) cases, for time period 1 (cases 1–21) and time period 2 (cases 22–42). Analyzing the docking times for individual cases over time revealed a decreasing trend; the mean docking time during the second period (cases 22–42) showed a significant reduction compared to the initial period (cases 1–21) (p = 0.004).

Figure 6

Responses as percentages (%) of the 21 completed questionnaires on surgeon’s physical demand.

Figure 7

Mean fatigue scores for specific body areas (1 = no discomfort, pain, or fatigue, 10 = worst imaginable discomfort, pain, or fatigue). The average fatigue score across all body areas was 1.4 points.