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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 779-783. doi: 10.19723/j.issn.1671-167X.2025.04.024

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Evaluation of the feasibility and safety of a Chinese developed modular surgical robotic system for robot-assisted pyeloplasty

Shihao LIU1, Liqing XU1, Xinfei LI1, Kunlin YANG1, Zhaoying LI1,2, Zibo ZHANG1,2, Xiang WANG1, Wei-xiao FU1, Zhihua LI1,2,*(), Xuesong LI1,*()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Nursing Department, Peking University First Hospital, Beijing 100034, China
  • Received:2025-04-30 Online:2025-08-18 Published:2025-08-02
  • Contact: Zhihua LI, Xuesong LI

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Abstract:

Objective: To evaluate the technical feasibility and perioperative safety of pyeloplasty assisted by the CarinaTM modular laparoscopic surgical robotic system in patients with ureteropelvic junction obstruction (UPJO). Methods: From November to December 2024, five consecutive patients diagnosed with UPJO underwent robot-assisted pyeloplasty using the CarinaTM modular laparoscopic surgical system at Peking University First Hospital. Data on patient demographics, intraoperative parameters (including docking time, console time, and estimated blood loss), perioperative outcomes, follow-up results, and surgeons' subjective evaluations of system performance were prospectively collected. Descriptive statistics were used; continuous variables were presented as median (range), and categorical variables as frequency and percentage. Results: The cohort included four females and one male. All the patients successfully completed the robotic procedure without conversion to open or conventional laparoscopic surgery. The median age was 32 years (24-37 years), and the median body mass index was 21.6 kg/m2 (15.8-27.3 kg/m2). The median docking time was 8 min (3-12 min), and the median console time was 91 min (71-125 min). Intraoperative blood loss was uniformly 20 mL. The median postoperative drainage duration was 3 d (0-4 d), and the median length of hospital stay was 4 d (4-9 d). No Clavien-Dindo grade Ⅲ or higher complications occurred. All the patients had their double-J stents removed at 2 months postoperatively, and pain in the ipsilateral flank, reported preoperatively by all the five patients, was alleviated. The subjective surgical success rate was 100%. Surgeons reported stable system performance throughout all the procedures, with no instances of mechanical arm interference or visual drift affecting surgical fluency. Conclusion: Preliminary findings indicate that pyeloplasty using the domestically deve-loped CarinaTM modular laparoscopic robotic system is technically feasible and perioperatively safe for the treatment of UPJO.

Key words: Robotic surgical procedures, Ureteropelvic junction obstruction, Pyeloplasty

CLC Number: 

  • R693.2

Figure 1

Intraoperative setup of the CarinaTM modular laparoscopic surgical robotic system for robot-assisted pyeloplasty A, the surgeon seated at the console performing the procedure using the robotic system; B, position of the patient-side cart relative to the patient after docking; C, port placement layout for pyeloplasty using the CarinaTM modular laparoscopic robotic system (O, camera arm port; R1, R2, R3, robotic instrument arm ports; M, assistant port.)"

Figure 2

Surgical steps of robot-assisted pyeloplasty using the CarinaTM modular laparoscopic surgical robotic system A, dissection and identification of the ureteropelvic junction(UPJ); B, longitudinal incision of the UPJ and the proximal ureter; C, pyelocaliceal stone removal via pelviotomy; D, posterior ureteropelvic anastomosis; E, antegrade double-J stent placement; F, anterior ureteropelvic anastomosis."

Table 1

Patient demographics and perioperative data"

Items Patient
1 2 3 4 5
Gender Female Female Female Female Male
Age/years 33 25 24 32 37
Body mass index/(kg/m2) 20.5 21.6 15.8 24.2 27.3
Previous surgical intervention No Yes Yes No No
Surgical side Left Left Left Right Left
Hydronephrosis Yes Yes Yes Yes Yes
Flank pain Yes Yes Yes Yes Yes
Presence of concomitant renal calculi No Yes No No No
Previous ureteral stent placement No Yes Yes No Yes
Underwent preoperative nephrostomy No No Yes No Yes
Preoperative creatinine/(μmol/L) 75.3 55.7 64.6 72.9 101.7
Postoperative creatinine/(μmol/L) 53.4 42.2 43.7 68.7 89.4
Estimated intraoperative blood loss/mL 20 20 20 20 20
Docking time/min 12 6 8 9 3
Robot-assisted console time/min 125 71 91 88 115
Postoperative length of stay/d 4 4 4 7 9
Postoperative drainage placement duration/d 3 0 4 3 2
Follow-up/months 6 6 6 6 5
Intraoperative device stability Yes Yes Yes Yes Yes
Device delays impacting surgery No No No No No
Intraoperative operability Yes Yes Yes Yes Yes
Device collision impacting surgery No No No No No
1
Fan S , Dai X , Yang K , et al. Robot-assisted pyeloplasty using a new robotic system, the KangDuo-Surgical Robot-01: A prospective, single-centre, single-arm clinical study[J]. BJU Int, 2021, 128 (2): 162- 165.
2
Moreno-Sierra J , Castillon-Vela I , Ortiz-Oshiro E , et al. Robotic Anderson-Hynes dismembered pyeloplasty: Initial experience[J]. Int J Med Robot, 2013, 9 (2): 127- 133.
3
Fan S , Xiong S , Li Z , et al. Pyeloplasty with the Kangduo Surgical Robot vs. the da Vinci Si Robotic System: Preliminary results[J]. J Endourol, 2022, 36 (12): 1538- 1544.
4
Pokhrel G , Wang Z , Cui J , et al. Initial experience with the novel modular robotic system Carina in urology: A prospective study on safety feasibility and surgical settings[J]. Sci Rep, 2025, 15 (1): 12686.
5
郑浩轲, 于栓宝, 王泽远, 等. 国产模块化手术机器人系统辅助肾部分切除术的可行性和安全性分析[J]. 临床泌尿外科杂志, 2025, 40 (1): 39- 42.
6
Wang H , Ye D . New surgical robotic platforms in China and their applications in urologic surgeries[J]. Asian J Urol, 2025, 12 (2): 134- 138.
7
应沂岑, 杜毅聪, 李志华, 等. 机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管狭窄[J]. 北京大学学报(医学版), 2024, 56 (4): 640- 645.

doi: 10.19723/j.issn.1671-167X.2024.04.016
8
Yang K , Yao L , Li X , et al. A modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction[J]. Urology, 2015, 85 (1): 263- 267.
9
Rasool S , Singh M , Jain S , et al. Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients[J]. J Robot Surg, 2020, 14 (2): 325- 329.
10
Abboudi H , Khan MS , Guru KA , et al. Learning curves for urological procedures: A systematic review[J]. BJU Int, 2014, 114 (4): 617- 629.
11
Bernie LH , Park K , Do J , et al. Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate[J]. Eur Urol, 2009, 56 (5): 848- 857.
12
Diana M , Marescaux J . Robotic surgery[J]. Br J Surg, 2015, 102 (2): e15- e28.
13
Bagrodia A , Raman JD . Ergonomics considerations of radical prostatectomy: Physician perspective of open, laparoscopic, and robot-assisted techniques[J]. J Endourol, 2009, 23 (4): 627- 633.
14
Turchetti G , Palla I , Pierotti F , et al. Economic evaluation of da Vinci-assisted robotic surgery: A systematic review[J]. Surg Endosc, 2012, 26 (3): 598- 606.
15
Moscarelli M , Harling L , Ashrafian H , et al. Challenges facing totally endoscopic robotic coronary artery bypass grafting[J]. Int J Med Robot, 2015, 11 (1): 18- 29.
16
Koukourikis P , Rha KH . Robotic surgical systems in urology: What is currently available?[J]. Investig Clin Urol, 2021, 62 (1): 14- 22.
17
李学松, 樊书菠, 熊盛炜, 等. 国产内窥镜手术机器人系统在肾部分切除术中的初步临床应用[J]. 中华泌尿外科杂志, 2021, 42 (5): 375- 380.
18
张忠, 代海涛, 刘远华, 等. 图迈国产机器人辅助腹腔镜在泌尿外科手术中的安全性研究[J]. 微创泌尿外科杂志, 2023, 12 (4): 229- 232.
19
Zhang W , Li H , Cui L , et al. Research progress and development trend of surgical robot and surgical instrument arm[J]. Int J Med Robot, 2021, 17 (5): e2309.
20
Rebuffo S , Ticonosco M , Ruvolo CC , et al. Robot-assisted pyeloplasty with HUGOTM Robotic System: Initial experience and optimal surgical set-up at a tertiary referral robotic center[J]. J Endourol, 2024, 38 (4): 323- 330.
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