Implementation of the Dexter Robot System in Daily Practice-First Experiences in Gall Bladder and Hernia Surgery

Abstract Background The use of surgical robots is increasing in the field of visceral surgery. Recently, new robotic platforms have entered the market. Dexter Robotic System is a computer-assisted surgical device with two working arms and one camera arm. Aims The purpose of this study was to assess the implementation this innovative robotic system in general visceral surgery. Methods This prospective study investigated the efficiency in elective cholecystectomy and inguinal hernia surgery of the Dexter robot. The Primary endpoints was safety, defined by device related adverse events. Secondary endpoints were performance of the Robotic System (defined as completion of the robotic procedure), operative parameters and surgeons’ comfort. Patients were consented for participation and the study was approved by the Ethical committee. Results The first 25 consecutive Dexter robotic assisted elective procedures (14 hernia, 11 cholecystectomies) were included. No device related adverse events occurred. 24 operations could be completed robotically. One hernia procedure was converted to a laparoscopic operation, due to a software failure of the Dexter-system. The median robot usage time were 55 minutes (IQR 41-5-79.5) for cholecystectomy and 95 minutes (IQR 90.5-115.25) in hernia, while the operating time amounted 99 minutes (IQR 84-133) in cholecystectomy and 131 minutes (IQR 124.75-153.75) in hernia. The median docking time of the Dexter robot was 7 minutes (IQR 7-10.5). Operators perceived comfort as high, median 4 (IQR 4-10.5, Discomfort Score range 4-16) and subjective stress levels as low, median 25 (IQR 10-35, Mental Effort Questionnaire range 10-60). (This study is ongoing, we expect to include 50 cases until June 2023). Conclusions This world's first clinical study of the Dexter Robotic System in general visceral surgery demonstrates a safe and efficient implementation of this innovative robotic system in clinical practice. Further studies will refine the effective applications of the Dexter Robotic System and its advantages over conventional surgical techniques.