Flexible suction-coagulation probe restores dexterity in robot-assisted surgery: bench-to-bedside evaluation.

OBJECTIVE

Rigid suction-coagulation probes constrain the wrist-like articulation that is central to robotic surgery. We therefore designed a 5-mm single-use flexible suction ball coagulator (flex-SBC) with a modified core design to restore dexterity and assessed its mechanical performance and early clinical feasibility, including the effect of the common robotic gripping strategies on suction flow.

METHODS

Preclinical. The new 7 × 7 core embedded in silicone was compared with the conventional 1 × 7 core design. Shaft pliability was quantified by sagging displacement and rebound force testing. Suction flow at - 20, - 30, and - 40 kPa was measured, and the impact of grip location (electrode base vs silicone shaft) and forceps type (fenestrated or Maryland bipolar) was analyzed statistically.

CLINICAL

The flex-SBC was used in 12 consecutive robotic gastrectomies with prospective collection of device performance, adverse events, and surgeon rating on seven-domain via three-point Likert scale.

RESULTS

Preclinical. Adopting the 7 × 7 increased mean sagging displacement from 15.6 ± 1.8 to 39.3 ± 3.2 mm (p < 0.001) and reduced rebound force from 0.288 ± 0.014 to 0.059 ± 0.004 N (p < 0.001). Mean flow rates were 6.76 ± 0.88, 8.87 ± 0.43, and 10.58 ± 0.40 mL/sec at - 20, - 30, and - 40 kPa, respectively-approximately half those of a rigid probe (all p < 0.001) but still exceeding published thresholds for effective evacuation. Gripping the silicone shaft, especially with Maryland forceps, sharply reduced flow (60% reduction; p < 0.0011).

CLINICAL

All operations were completed without device-related malfunctions, injuries, or conversions. Of 84 survey ratings, connection setup, suction efficiency, tissue safety, and overall satisfaction were "satisfactory" in 100%; maneuverability was "satisfactory" in 65% and "average" in 35%. No "unsatisfactory" scores were recorded.

CONCLUSIONS

The flex-SBC bends where the robot bends, enabling safe, practical use across robot-assisted upper-GI surgery. Grip technique influences device performance, providing important implications training. Larger comparative trials should clarify whether these ergonomic gains translate into shorter operating times and improved oncologic precision.