ACS DR Stephan Senhance Presentation

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

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

Features of the system
Safety first!
High flexibility via individual arms

Based on laparoscopic motion
Versatile
Open platform design
Responsible economics

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

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

Ergonomics
Surgeon
&
Assistants

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

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

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

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

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)

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!

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

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

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!

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

Thank you for your attention
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)

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First Experience

First Experiences with the Senhance Robotic System

Dr. Dietmar Stephan

1200+ minimally invasive procedures / year

In addition, a variety of appendectomies,

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

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

High flexibility via individual arms

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

Open view of operating room

Hybrid surgery: open source

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

5 mm instruments architecture (now 3 mm CE Mark)

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

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

We work most with a monopolar

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

This is how we started:

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

62 inguinal hernia repairs (TAPP) one side

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

Average docking time over all operations 8,6 min

No measurable blood loss in all operations

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

Learning Curve: Short

Average Cockpit Times (Dr. Stephan)

Average Cut Suture Time

Benchmark: Average cut suture time

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

Ergonomic Benefits for the Surgeon

Extremely comfortable ergonomic position of the surgeon

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

First two cases in October 2017

Steps of the robotic part

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

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

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

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

The operating times were below the expected duration, and

Last but not least: Its FUN!

We will continue Colorectal Surgery with existing system

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

Dr. Dietmar Stephan

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