Safety and Efficacy of SHURUI Single-Port Serpentine-Arm Robotic Surgery System in Lung Surgery: A Prospective Single-Centre Study

Abstract

Objectives: The integration of robot-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (VATS) is poised to become a key direction for future advancements. The SHURUI single-port (SP) Robotic Surgery System, China's first domestically developed SP endoscopic system, has shown promise in urological and gynaecological surgeries but lacks thoracic application data. This study evaluates its safety and efficacy in anatomical lung resection.

Methods: A prospective single-centre trial enrolled 15 patients undergoing robotic pulmonary resection. The SHURUI system, featuring serpentine-arm instruments with dual continuum mechanisms, was deployed via a fifth/sixth intercostal incision. Primary endpoints included the non-conversion rate and the incidence of device-related or potentially device-related surgical complications meeting Clavien-Dindo grade 3 or higher criteria; secondary endpoints encompassed operative time, blood loss, pain scores, surgeon satisfaction, the incidence of adverse events, transfusion rates, 30-day readmission rates, 30-day reoperation rates, and 30-day mortality.

Results: All procedures (8 lobectomies, 5 segmentectomies, and 2 sleeve lobectomies) achieved 100% non-conversion, with one case requiring an auxiliary port. Median total operative time, port creation time, docking time, and console time were 174 minutes (117-335), 14 minutes (8-30), 4 minutes (3-6), and 117 minutes (56-233), respectively. Blood loss was 100 mL (10-300), and the median hospital stay was 5 days (3-12). Postoperative pain scores according to the numerical rating scale (NRS) were 3, 3, and 2 at 1 hour, 24 hours, and 72 hours. Surgeons reported 95/100 median satisfaction. Two minor complications (prolonged air leak, anaemia) resolved conservatively; one readmission for pleural effusion required thoracentesis. No mortality was observed within the 30-day postoperative period.

Conclusions: This study demonstrates the feasibility and acceptable safety of using the SHURUI SP robotic surgery system for anatomical lung resection.

Clinical registration number: The study protocol was registered at http://www.chictr.org.cn/ (ChiCTR2400084046).

Keywords: anatomical lung resection; efficacy; safety; single-port robotic surgery.

Graphical abstract

Figure 1.

Components of the SHURUI SP Surgical Robotic System. (A) Surgeon manipulates robotic arms through a high-definition interface at the console. (B) External view of the patient-side surgical platform. (C) Customized flat cannula accessing the thoracic cavity via intercostal incision. (D) Single-arm deployment of instruments and endoscope through the cannula, with external robotic arm maintaining positional stability. Abbreviation: SP, single port

Figure 2.

Operative Workflow of the SHURUI SP Surgical Robotic System in Standard Anatomical Lung Resection (Exemplified by Right Middle Lobectomy). (A) Dissecting the underdeveloped interlobar fissure. (B) Isolating the right middle pulmonary vein. (C) Dissecting the right middle bronchus. (D) Isolating the right middle pulmonary artery. (E) Lymph node dissection at the pulmonary hilum and peribronchial region. (F) Mediastinal lymph node dissection. Abbreviation: SP, single port

Figure 3.

Key Procedural Steps of the SHURUI SP Surgical Robotic System in Complex Pulmonary Surgery. (A) Bronchial anastomosis using PROLINE suture. (B) Bronchoplasty following bronchial transection. (C) Dissection and mobilization of subsegmental pulmonary vessels. (D) Isolation of subsegmental bronchi. Abbreviation: SP, single port

Figure 4.

The Application of Non-Robotic Instruments: (A) Non-robotic instruments are introduced through the physical space adjacent to the flat cannula of the intercostal incision. (B) An assistant is a senior and highly experienced surgeon. (C) The use of linear cutting and closing devices. (D) The use of a specifically designed slender suction apparatus.