Da Vinci SP system: the next generation of robotic-assisted surgery

The introduction of the Da Vinci Single Port (SP) system enables the Mainz University Medical Center to expand its field of application for minimally invasive surgery in general surgery as well as visceral and transplant surgery. Robotic-assisted surgery improves medical practice through the use of state-of-the-art technology that enables more precise and less invasive procedures.

With the help of robotic systems, complex operations can be performed with greater accuracy and safety. In an interview with MEDICA-tradefair.com, Prof. Peter Grimminger explains the advantages of the new SP system for patients as well as the future application possibilities in various surgical disciplines.

Prof. Grimminger, what advantages do you expect for patients and how will this affect treatment practice in your clinic?

Prof. Peter Grimminger: We already have two Da Vinci multiport systems at the Mainz University Medical Center. The new single-port system, which operates via a single robotic arm, opens up new access routes in addition to the existing multi-port system techniques. The ability to operate tunnel-like via a single access route expands our treatment spectrum of robot-assisted operations. We are still evaluating the extent to which the SP system can be used in various operations. This is a dynamic process.

I see it as a supplement for certain operations. It will not replace all existing surgical methods, but will be used as an additional robot-assisted system on an individual basis and for special procedures. However, it offers advantages, particularly in my main area of focus, esophageal surgery: for example, we could operate through the diaphragm without penetrating the thorax and thus leave certain areas of the body untouched.

I like to compare it to the automotive industry: you can reach your destination with any car, but depending on the route, there are different vehicles that are more suitable. For example, an off-road vehicle is suitable for dirt tracks, whereas a Ferrari would be unsuitable there. The new SP system can do a lot of what the multiport system offers, but it does not yet have all the instruments of the multiport system. The multiport system is the flagship and the basis on which the SP system is built.

Are there any additional qualifications that you need to acquire in order to operate the SP system?

Grimminger: The SP system is approved for urology and ENT in the USA, as well as for a wide range of surgical indications in Asia and now also in Europe. New instruments and settings are constantly expanding the areas of application as robotic techniques continue to develop dynamically. This makes operations possible that were unthinkable a few years ago.

The SP system differs from the multiport system in the way it works. Although the console control unit looks the same, there are additional functions and the handling is different. With the multiport system, operations are performed in the laparoscopic area using the keyhole orientation with fixed arms. The SP system, on the other hand, enables movements like in space: you can move all instruments freely individually or in combination. This creates new options and experiences.

How will the newly established W2 professorship for robotic surgery strengthen the position of the Mainz University Medical Center as a center for robotic surgery?

Grimminger: You shouldn't expect the industry to deliver innovations that can be used immediately by everyone and everywhere. It takes experts working together to establish these highly complex systems for widespread use. The situation was similar 20 years ago with the multiport system: only a few people had it and it gradually evolved. Since then, several new generations of instruments and procedures have been added. The SP system will probably develop in the same way. This is the only way to ensure that it can be used across the board for all patients.

With the newly established W2 professorship for robotic surgery, the Mainz University Medical Center is also continuing to develop in this area of cutting-edge university medicine. We are taking on a pioneering role in establishing the SP system in general, visceral and transplant surgery. Our fundamental aim at the University Medical Center Mainz is to develop comprehensive expertise in operations using multi-port and single-port surgical systems. To this end, we want to work on an interdisciplinary basis with Urology, ENT and later also Gynecology, and also use robot-assisted surgery there for operations that were previously performed without it.

What are specific examples of areas of application where the SP system is particularly beneficial?

Grimminger: I have been working with this device in studies for over five years and was therefore already aware of its potential. At the Mainz University Medical Center, we have been using the SP system in general, visceral and transplant surgery since it was approved for use in Europe. As the SP operating system enables complex procedures to be performed in a small space, it could also be well suited for operations on urological and ENT patients.

In visceral surgery, I see great potential for esophageal surgery, as the mediastinum is located in a confined space and we are sometimes unable to operate through the thorax. In the past, such operations were not performed or had a high mortality rate. The SP system makes it possible to perform complex oncologic surgery through small tunnels without touching sensitive areas. It is also advantageous if the lungs need to be spared or if there have been many previous operations.

How can the combination of robot-assisted technology and high-resolution 3D imaging improve surgical precision and efficiency?

Grimminger: Even if robot-assisted surgical systems do not operate autonomously, they offer valuable assistance. The advantage of these robotic systems is that we overcome the tactility of open surgery and make interventions measurable and evaluable. This means that if the medical professional performing the operation has a coughing fit, for example, any movement is not transferred to the patient. This minimizes the risk of injury.

One major advantage is that the surgeons and patients are digitally connected. The technology allows us to automatically record, measure and store what happens in the operating theater and how and with which images. This digital data enables us to constantly monitor and comprehensively analyze our operations afterwards.

In addition, there are already approaches and functions for optimized safety in which the operating surgeons are alerted to errors by the robotic systems during an operation or their incision is analyzed. In this way, the system helps to prevent cutting into sensitive structures by recognizing them in advance, and injuries to the pericardium, lungs or intestines, for example, can be better avoided.

In addition, we can create a "surgical fingerprint" and optimize skills by analyzing it. Ultimately, these improvements enable us to achieve a higher quality of care for patients. This is also a key argument for the widespread use of robot-assisted systems.