Implementation of a Robotic Surgical Program With the Dexter Robotic Surgery System: Initial Experiences in Cholecystectomy.

Abstract

The use of surgical robots in minimally invasive visceral surgery is increasing, with new platforms like the Dexter Robotic System. This study evaluated the implementation of Dexter in a general visceral surgery department, focusing on safety, performance, and surgeon stress in elective cholecystectomy. Three surgeons with varying laparoscopic and robotic experience performed robotic cholecystectomies with Dexter between December 2022 and June 2024. Perioperative outcomes and safety data were collected until 30 days post-surgery. Surgeons' stress load and physical discomfort were assessed using validated questionnaires (SMEQ, STAI, and LED). Fifty-nine patients underwent elective gallbladder removal. Median age was 52 years (range 27-85) and BMI 26.3 kg/m² (range 18.3-41.2). All surgeries were completed robotically without conversion to open surgery. There were no intraoperative complications or device deficiencies. Two cases were converted to laparoscopy due to patient anatomy and a liver tumor discovery. One postoperative complication (Clavien-Dindo grade 3A) involved choledocholithiasis requiring ERCP. Median total operating time, docking time, and console use time were 60 min (IQR 50-78), 5 min (IQR 4-7), and 23 min (IQR 19-34), respectively. Operative times revealed a fast-learning experience, stabilizing after 10-15 cases. Surgeons reported high comfort (LED Median 3, IQR 0-6) and low stress (SMEQ median 10, IQR 10-26.25). The Dexter system was safely implemented in clinical practice, with efficient learning curve and low perceived stress, even for surgeons without prior robotic experience. Further studies are needed to determine whether Dexter offers advantages over conventional techniques.