Impact of Surgeon-Controlled Suction During Robotic Prostatectomy to Reduce Dependence on Bedside Assistance

Abstract

Background: Suction during robotic surgery has traditionally been performed by a bedside assistant. Adequately skilled assistants are not always available. We assessed a purpose-designed robotic surgeon-controlled suction catheter for efficiency and safety by comparing with historic cases of suction controlled by a dedicated bedside assistant using standard rigid laparoscopic suction. Methods: Beginning in February 2019, the remotely operated suction irrigation (ROSI) device was used in all robotic prostatectomy procedures, which is a flexible suction catheter manipulated by the surgeon such that a bedside assistant is never required for suction. The initial 300 consecutive cases performed with ROSI were compared with the 300 immediately previous procedures using bedside assistant suction (BAS). Results: There were no statistically significant differences between groups in age, body mass index, American Anesthesiologist Association score, prostate specific antigen, or pathologic stage. Lymph node dissection was performed in all 600 patients. All 300 ROSI cases were completed without requiring switching to BAS. Estimated blood loss (102.7 vs 120.2 mL, p = 0.001) and operative time (156.1 vs 149.3 minutes, p < 0.001) were slightly lower in the ROSI group. There was no statistical difference in the 90-day complication rate (Clavien ‡III) between groups, with both having 3% of patients readmitted or seen in the emergency department within 90 days of surgery. Conclusion: Surgeon-controlled suction allowed more surgeon autonomy without a negative impact on efficiency or safety issues requiring ''bailout'' suctioning by the bedside assistant whether urgent or otherwise. Robotic surgeons without access to skilled bedside assistants should consider suctioning for themselves not unlike the norm for many laparoscopic surgeons.

Suctionable Gauze Ball Operated by the Console Surgeon Overcomes Wet Scenes during Robotic Rectal Surgery

“…Several suctioning methods that use either a remotely operated suction and perfusion system (ROSI) [5], a catheter with a basket-like metal devices attached to the tip [6], or a modified assistant suction tube [7] are reportedly effective, but only for suctioning purposes. Our unique suction system is similar to systems described in these previous reports in that it allows for provision of suction in the narrow pelvic cavity, and it also allows the console surgeon to perform suction independently without relying on an assistant surgeon.…”

“…The console surgeon is therefore often faced with a compromised surgical view, particularly when patients have advanced cancer or have completed preoperative chemoradiotherapy, which tend to lead to accumulation of exudate and blood in the pelvis. The use of existing robotic suction tools, including the EndoWrist One Suction Irrigator (Intuitive Surgical Inc., Sunnyvale, CA, USA); remotely operated suction and perfusion systems (ROSI) [5]; catheters with basket-like metal devices attached to the tip [6]; and modified assistant suction tubes [7] from the assistant port; has been reported, but none of these methods combine simplicity with cost effectiveness. There is room for improvement.…”

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

“…Multiple approaches have been developed to circumvent around these limitations. The remotely operated suction irrigation (ROSI) system is surgeon-controlled and minimizes reliance on a bedside assistant for suctioning in patients undergoing SP or MP surgery including RARP ( 77 ). The use of a non-invasive magnetic retraction device (Levita™ Magentic Surgical System, San Mateo, CA) has been described in RARP using both SP and reduced-port approaches ( 78 , 79 ).…”

A newly developed surgeon‐controlled suction device in robotic‐assisted thoracoscopic surgery

“…In video-assisted thoracoscopic surgery, a suction cannula can be used as a surgeon-controlled instrument to secure the field of view with organ retraction. Although there have been studies on developing surgeon-controlled suction devices for robotic-assisted surgery, [1][2][3] these devices can be difficult to manipulate while performing other manipulations with both arms already engaged.…”