Robot-assisted laparoscopic partial nephrectomy with Alf–X Robot on pig model

INTRODUCTION & OBJECTIVES: The introduction of the robotic surgical systems has changed the way both surgeons and patients view
urological surgical procedures. We tested the same theoretical and tangible benefits for partial nephrectomy with Robot Alf-X. We review
our technique of robot-assisted laparoscopic partial nephrectomy performed using a new robotic device (Alf – X) on swine large
white/Landrace model.
MATERIAL & METHODS: We set up an operating theatre to test Alf-X on partial nephrectomy procedure to be performed on swine large
white/Landrace in total anesthesia. The console incorporates the following main components: an ergonomic seat, the Robotic Master (RM)
with haptic handles, a 3D-HD monitor, an eye-tracking system (ETS), a keyboard and a touchpad, and one foot pedal. The ETS is an
infrared-based eye tracking system that detects which point the surgeon is looking at. There was one surgeon placed at computer-console
and one surgeon placed at the surgical table. A random decision on the kidney to be tested is performed before the operation. Once the
trocars are placed and the kidney isolated a period of warm ischemia is due to perform the partial nephrectomy on the lower or upper pole
(random choice). The haptic sensation can be used for pushing or pulling to estimate elasticity and consistency of tissues and controlling
the tensility of the sutures when tying. Low-cost disposable or reusable instruments were used.
RESULTS: To date, we performed 7 partial nephrectomy with Alf-X robot on swine large white/Landrace (pigs) models. Three robot’s arms
were used. 5 partial nephrectomies were on the right kidney, while 2 were on the left one. The mean surgical time was 32.42 minutes
(range 45-18 min). The mean warm ischemia time was 9.4 min (range 7.4-12 min). The mean blood loss was 48.6 ml (range 20-90 ml).
CONCLUSIONS: According to these experimental experiences on pig models, we may assume that robot-assisted laparoscopic partial
nephrectomy, using Alf-X is safe, feasible and reproducible procedure. Moreover it offers a good perception when instruments touch each
other avoiding collision between robotic arms. We believe that robot-assisted surgery approach could be reasonable an innovative
contribution in the near future also in humans. It also offers a reduction of costs per intervention.