OR robotics: flexible on-demand robotics with Dexter

Surgical robotics is precise and reduces the workload of surgeons. However, it is not always as flexible as humans. Dexter, a surgical robot that recently received CE certification, could revolutionize how surgery is performed in certain cases. Not only is it smaller and less expensive than other systems, it also allows switching between robotics and laparoscopy.

In this interview with MEDICA-tradefair.com, Prof. Hanno Matthaei and Dr. Jan Arensmeyer talk about how on-demand robotics works, the advantages it brings, and what it takes to establish a new system in the OR.

Prof. Matthaei, Dr. Arensmeyer, what exactly do you mean by on-demand robotics?

Prof. Hanno Matthaei: In robotic surgery, the surgeon sits at a console and controls the robot from a distance of a few meters, which usually performs the procedure from start to finish. This is also known as the "master-slave principle". However, until now, work at the console has not been sterile. This means that in an emergency, for example, the surgeon must first wash up sterilely, and the robot must be moved aside before the surgeon can approach the table directly and operate on their own.

On-demand robotics is a new approach here, where we use a much simpler, smaller system, for example the Dexter robot. We can freely choose when to use it during the procedure and dock it to the operating table and the patient. This is usually the case for complex steps, for example, suturing an anastomosis in the gastrointestinal tract, where robotics offers technological advantages. However, we can also choose to perform a classic laparoscopy instead of robotic surgery if, for example, this is easier and faster in a specific case.

Since we do not necessarily perform a robot-assisted operation with Dexter from start to finish, but only use it "on demand", we can also coordinate operations in neighboring rooms, for example, so that the robot is shared between the surgical teams.

How long has this method been around?

Matthaei: On-demand robotics is a relatively new approach. However, this is not a fixed term, but rather a description. The Dexter robot is particularly suitable for this because it is relatively small and is the only system that allows you to sit sterilely at the console. It was manufactured specifically for this concept. Whether this process will become established will be seen in the future.

Where do you see the greatest advantages of the procedure?

Matthaei: Because we can be at the table ourselves very quickly if necessary, patient safety is a particular focus, for one thing. The smaller size of the system and the potential cost efficiency of the on-demand approach also make a kind of democratization of surgical high technology conceivable. Hospitals that have been unable to afford a very costly system could potentially reap the benefits of surgical robotics across departments by sharing a smaller system and using it efficiently. Our team sees it as an imperative to bring technological advances in surgery to as large a patient population as possible. From that perspective, this concept is very interesting!

Dr. Jan Arensmeyer: The possibility to operate hybrid with laparoscopy and a simplified robotics enables an optimization of the OR operation. From our point of view, the modular concept of the Dexter system will also shift the application spectrum in terms of economic operation in the future.

We tend to perform very demanding procedures with the DaVinci system. However, there is also a middle segment of procedures that are not quite as complex but can benefit from the advantages of robotics. In my view, a simplified system therefore offers the opportunity to implement robotics on a widespread basis.

With regard to the organization of the OR, the preparation, the workload for the OR staff – are the processes different with Dexter?

Matthaei: Basically, the processes are quite similar. The modular system also has certain lead times, but they are comparable with other systems.

Arensmeyer: The important thing is that when a new system is introduced in the OR, you always have to get the entire team on board. There are special features in all processes that the staff must be familiarized with so that they can function as a team. This is especially true for robotics, which is technically more complex – there are more components that have to be integrated. That simply requires this special attention.

Matthaei: In principle, everyone has to pull together. And here at the UKB, we have what is probably a unique team for surgical robotics, which has made the introduction of the system possible despite the otherwise very demanding daily hospital routine. You certainly need a certain mindset to welcome innovative changes that are sometimes "uncomfortable", to find them interesting and to support them. However, our team allowed and supported this in all sectors, which is why the implementation went smoothly.

How did you prepare for the use of Dexter?

Matthaei: At first, we only got to know the system theoretically, then we followed a dry lab training of several months on the system and simulators in our center. In between, we were able to train at training centers in Switzerland and France on body donations, among other things. Only recently we performed our first operation.

Arensmeyer: In all our project activities, we always keep patient safety in mind as a key aspect, because technology is extremely dynamic at the moment. This applies not only to robotics, but also to the integration of AI-supported decision-making aids and augmented realities.

All of these combined will present us with very exciting but also challenging changes. Therefore, as a surgical team, we have given a lot of thought to how we can implement technologies with maximum patient safety and also sustainability. To some extent, this also goes beyond the expertise of the surgical community, which is why we have networked with partners from ethics and law both within and outside the university.

How and when would you use on-demand robotics in the future?

Matthaei: In principle, on-demand robotics can be used for all operations that would otherwise be minimally invasive. Of course, this procedure is particularly advantageous for complex surgical steps, where experience has shown that we benefit from the advantages of robotics – for example, when high magnification, 3D visualization and fine, tremor-free preparation of structures are required. Due to its simplicity, Dexter is also particularly suitable for surgical teaching and training.

Since this system can also be used to perform less complex operations efficiently, for example gall bladder removals or inguinal hernia closures, young surgeons can also be introduced to the topic of robotics in an uncomplicated manner. It is advantageous to sensitize doctors to the topic of "digital surgery" as early as possible and to get them excited about it, as this is without question the future.

We also see enormous potential for research and development in very different areas in the coming decades, which, in addition to patients, could be extremely beneficial to Germany/Europe as a business location if we are involved at an early stage.