Robotics-assisted surgery offers several advantages, including tremor reduction, enhanced precision, shorter learning curves, and improved surgical and oncological outcomes.5–7 Robotic surgery has significantly impacted radical prostatectomy, combining the advantages of open and laparoscopic techniques while enabling precise manipulation at the pelvic floor. We evaluated the effectiveness and safety of Saroa, a novel surgical assistant with tactile feedback, in RARP.
Recent advancements in surgical robots prioritize replicating the dexterity of surgeon hand movements during minimally invasive procedures.8,9 However, tissue damage caused by excessive force during organ manipulation remains a critical concern. The Saroa system addresses this challenge by incorporating tactile feedback, allowing surgeons to perceive resistance while grasping. This is particularly beneficial for surgeons with limited laparoscopic experience, allowing gentler tissue handling.10 Although a firm grasp may be necessary for certain instruments, such as needles, this can lead to finger fatigue. Notably, the grasping force required differs significantly between prostate and bladder tissues (Fig. 4); this emphasizes a key advantage over the da Vinci system, which primarily relies on visual cues for bladder neck dissection. Using Saroa, the bladder neck can be recognized using visual and tactile feedback. This dual-sensory approach could broaden its utility in various surgeries. Furthermore, the ability to determine the exact dissection plane through tactile grasping may help surgeons perform higher-quality surgeries.
Saroa incorporates several innovative features designed to enhance precision and workflow in minimally invasive surgery. One key feature is a roll clutch system that facilitates highly precise needle movements, particularly during deep, delicate insertions. Unlike conventional robotic platforms with limited arm rotation, Saroa permits continuous needle driving, minimizing tissue damage. This enhanced control improves needle handling and allows surgeons to perform a wider range of surgical maneuvers. Furthermore, its open console design promotes better communication between the operating surgeon and the surgical team, enabling multiple surgeons to visualize the procedure simultaneously in 3D.
In our study, the operation took longer using Saroa. This might be attributable to the unfamiliarity of surgeons with the system vs. da Vinci Xi and the absence of a fourth robotic arm. The fourth arm plays a crucial role in procedures such as RARP, which provides necessary tension on pelvic floor organs. This function must be performed by an assistant surgeon when using Saroa, increasing operation time due to reduced coordination in early robotic surgeries; however, surgeon–assistant coordination is improving with practice. Moreover, plans are underway to introduce two more arms. However, the current three-arm design offers advantages in weight and size, simplifying installation in operating rooms of varying dimensions. Furthermore, its compatibility with standard endoscopes, trocars, and equipment significantly reduces operating costs compared to conventional systems.
Our study is the first to evaluate the effectiveness and safety of Saroa in RARP. Although surgeons experienced in robotic surgery performed the procedures safely, operative times were slightly extended. Further investigation is warranted to assess long-term oncological and functional outcomes following RARP with Saroa.