First Clinical Use of 5 mm Articulating Instruments with the Senhance® Robotic System.

Introduction: While the well-known DaVinci ® robotic system (Intuitive Surgical, Inc., Sunnyvale, CA) uses 8 mm articulated instruments, the Senhance ® robotic system (TransEnterix, Morrisville, NC), available since 2016, uses 5 mm instruments, which is the standard size in laparoscopy. We report here the first 43 procedures using 5 mm articulating instruments with the Senhance ® system (TransEnterix).

Methods: From September 9, 2019, to January 15, 2020, we performed 43 various robotic-assisted abdominal procedures. Before the first clinical intervention, the surgeons and surgical nurses were trained in the handling and operation of the articulating instruments. The main procedure was Inguinal Hernia Repair with the TAPP technique. We performed the operations with a 5 mm articulating bipolar forceps and a 5 mm articulating needle holder. In all cases, the Senhance ® (TransEnterix) articulating instruments were inserted through a 5 or 10 mm trocar, connected to the robotic arm and used for tissue dissection (inguinal hernia repair, cholecystectomy, and sigmoid resection) on the left hand of the robot arm and for suturing (inguinal hernia repair) on the right hand of the robot arm.

Results And Discussion: We observed technical issues in three patients: two resulted from user error and one occurred due to a software update. No technical issues were observed in the remaining 40 cases. There were two unscheduled conversions to laparoscopic surgery and no conversions to open surgery. No case of damage to surrounding tissue was observed. In one case, the branches of the grasper were jammed due to severe clot buildup after extensive coagulation following a strong bleed. After unproblematic laparoscopic bleeding control, robotic surgery was continued. There were no further intraoperative or early postoperative complications. The first impression of the participating surgeons and surgical nurses was that the smaller instruments were easy to handle after special training and offered a wider range of movement within the surgical field. All of the surgeons involved saw advantages with the use of 5 mm articulating instruments.

Conclusion: Senhance ® (TransEnterix) 5 mm articulating instruments are technically stable and can be safely used in various abdominal procedures. The initial results suggest that these 5 mm articulating instruments can be a supportive tool in further robotic surgery, providing advantages in suturing and dissection with less risk of injury to surrounding tissue.