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First Experience

First Experiences with the Senhance Robotic System


(TransEnterix)

Dr. Dietmar Stephan


Department of Minimally Invasive and Robotic Surgery
Clinic of General-, Visceral- and Vascular Surgery
(Chief: Prof. Dr. F. Willeke)
21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Department for Minimally Invasive and
Robotic Surgery

1200+ minimally invasive procedures / year

350+ cholecystectomies
500+ hernia repairs (inguinal / TAPP and
ventral hernia / IPOM)
100+ operations on the upper
gastrointestinal tract (reflux surgery with
implants of anti reflux stimulation
systems, fundoplication, bariatric surgery)
100+ Colorectal procedures

In addition, a variety of appendectomies,


adhesiolysis, as well as splenectomies and
adrenalectomies

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Brief Introduction of the System

We needed a multi versatile robotic system for General Surgery; its the
future
Needs driven by: market advantages, surgeon advantages, hospital growing
to academic center
Features of the system meet our criteria

We dont need
a robot for the
corner

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Features of the system

Safety first!

High flexibility via individual arms


Based on laparoscopic motion
Versatile
Open platform design
Responsible economics

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Features of the System

Highlights:
Haptic feedback
3rd hand via 3DHD vision
controlled via eye-sensing

Open view of operating room

Hybrid surgery: open source


ports allow robotic and
traditional lap instruments work
simultaneously

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Features of the System

5 mm instruments architecture (now 3 mm CE Mark)


Standard trocars
Trocar placement like standard laparoscopy
Docking easy & quick
Easy change instruments, without changing trocars
Easy and quick patient repositioning

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Ergonomics

Surgeon
&
Assistants

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Wide Portfolio
Responsible Economics
22 reusable instruments, 5-10 mm straight & articulating
Reducing cost per procedure

We work most with a monopolar


hook and bipolar grasper

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
The Senhance System at the
St. Marienkrankenhaus Siegen

This is how we started:


Onsite training of 3 surgeons and 2 nurses in March 2017 in Milan
Started to operate straight the week after
Today: 2 full days of robotic surgery every week
Starting relatively easy (inguinal hernia repair) procedures before moving to
more complex, first upper GI
Always have back-up plan; can go back to LAP!
Now also the GYN team is starting to work!
Since October colorectal surgery

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
First Experiences

Procedures/Cases
116 cases from March 14 until October 19

62 inguinal hernia repairs (TAPP) one side


17 inguinal hernia repairs (TAPP) both sides
10 ventral hernia repairs (IPOM) + Adhesiolysis
9 implants of an anti refluxstimulation system (Endostim)
9 Nissen + Toupet fundoplications
1 operation of a Dunbar Syndrome (compression-syndrome of
the coeliac trunc)
6 Cholecystectomies
2 Sigmoid resections

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
First Experiences

Intraoperative Times
(69 cases March 14 to July 29)

Average docking time over all operations 8,6 min


Average docking time last 20 procedures 7,0 min
Fastest docking time 3,0 min

No measurable blood loss in all operations


In one case bleeding of the ventral abdominal wall after
incision of the peritoneum with the electrical hook which
was laparoscopically stilled

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
First Experiences

Learning Curve: Short


(29 one side inguinal hernia repairs without additional procedures
like adhesiolysis)

Average Cockpit Times (Dr. Stephan)


for unilateral inguinal hernia repair without additional procedures like
adhesiolysis (29 cases) 36,8 min
Last 10 procedures 28,6 min
Fastest time 18,0 min

Average Cut Suture Time


for unilateral inguinal hernia repair < 55,0 min

Benchmark: Average cut suture time


for laparoscopic procedure TAPP technique 59,0 min
(World J Surg. 2012)

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
First Experiences

Ergonomic Benefits for the Surgeon

Extremely comfortable ergonomic position of the surgeon

Low-fatigue work

Arms, shoulders and upper body can be left in a relaxed posture

Relaxed surgeon better for the patient!

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Start of Colorectal Surgery

First two cases in October 2017


Both cases: Sigmoid resection in a case of covered perforated
sigmoid diverticulitis

Steps of the robotic part


1. Mobilization of the left flexure
2. Mobilization of the descending colon
3. Preparation of the sigmoid

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Conclusion: Our Initial Senhance
Experience YTD

All patients are documented in a register study and a complete video documentation of
each operation is performed

Detailed results on the TAPP hernia will soon be published in a separate study

Only technical problems: 1 x reboot necessary and then continued fine, 1 x in the
beginning I dropped the right handpiece and it got impacted but repaired

2 cases where we switched to laparoscopy; No conversions to open


Case: Bleeding in the abdominal wall stilled by laparoscopy without issues
Case: Strong adhesions in the mediastinum in thoracic tracts, so without energy device we decided to change
to laparoscopy for safety reasons

1 complication
Case: ventral hernia with strong adhesions of the small intestine: late infection with revision in case of
coagulation damage

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Conclusion: Our Initial Senhance
Experience YTD
No measurable blood loss

Early discharge patients after hernia repair, 1st postoperative day in a


good condition and with a low level of pain

The operating times were below the expected duration, and


approaching speed of laparoscopy

General benefits:
Improvement surgeon ergonomics/relaxed position
Enhanced precision & control
Perhaps reduced bleeding (we have to verify this in further studies)
Advanced visualization under surgeon control
Efficient and productive in our hospital

Last but not least: Its FUN!


21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
The next steps will be started soon:

We will continue Colorectal Surgery with existing system


Sigmoid resection/Rectum resection/Rectopexy
Expanding platform with further energy devices and more articulating
options

We will begin with Microlap Robotic Inguinal Hernia Repair (TAPP): 3mm
Senhance instruments now CE Marked.
Using only one10 mm trocar at umbilicus (camera/mesh)
Two 3mm instruments directly through the skin
It works very well in preclinical labs
We will begin soon and publish the results of the first 50 cases in
spring 2018
We expect less pain and a better cosmetic results

21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem


Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
Thank you for your attention
21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)
First Experience
First Experiences with the Senhance Robotic System
(TransEnterix)

Dr. Dietmar Stephan


Department of Minimally Invasive and Robotic Surgery
Clinic of General-, Visceral- and Vascular Surgery
(Chief: Prof. Dr. F. Willeke)
21.03.2017 Klinik fr Allgemein-, Viszeral- und Erste Erfahrungen mit dem
Gefchirurgie (Chefarzt: Prof. Dr. F. Senhance Robotic System (Fa.
Willeke) Transenterix)