The Future of Revo-i and the Single-port Approach

A symposium was held to discuss clinical application cases of meerecompany’s “Revo-i,” a Korean surgical robot system developed with its own technology, and share up-to-date robotic surgery techniques. meerecompany (CEO Joon Koo Kim) held the symposium on 2nd November 2022 in celebration of achieving 100 OBGYN cases of robotic surgery using Revo-i in Busan Queen’s Park Women’s Hospital. Around 50 OBGYN specialists from Busan, Ulsan, and Changwon attended the symposium. Presentations on the clinical experiences, know-how, and achievements met using Revo-i were also given at the symposium.

Professor Keun Ho Lee of the department of Obstetrics and Gynecology at the Catholic University of Korea Seoul St. Mary’s Hospital gave a special lecture on the “highly sophisticated robotic surgery performed with Revo-i in gynecology.” Professor Lee emphasized that the potential of Revo-i was demonstrated especially with the attempt of the transformed single-port approach, and that such potential is expected to grow even more in the future. This article summarizes the presentation given by Professor Lee. For the full article in Korean, please click here.

I have extensive experience in new surgeries using Revo-i with cadavers and also performed many real clinical applications. So, based on my experience in use of Revo-i in cadavers and real clinical settings, let’s discuss how Revo-i can be applied to the single-port approach.

Many doctors around my age have witnessed and experienced the appearance of many new surgical tools such as open surgery as well as vaginal surgery, laparoscopy, single-port, and robotic surgery. So, I believe they will properly perform surgeries with any tools at their disposal because they are familiar with handling new tools. In this regard, I think learning about the surgery itself is more important.

An open surgery for hysterectomy was documented in 1843 for the first time by Charles Clay. Later, Harry Reich attempted total laparoscopic hysterectomy for the first time in 1988. In 2002, Diaz was the first to attempt robotic surgery. The robotic surgery was then approved by the FDA in 2005. As you can see, surgical techniques have changed significantly compared to 20 years ago. And it will keep developing for upcoming 5 to 10 years. I guess robotic surgery will become more universal, and single-port surgery will expand as time goes on.

Revo-i, the first Korean surgical robot system developed by meerecompany

Our country is seeing an increase in the use of the robotic surgery in OBGYN. Among them, around 25% is the single-port robotic surgery. I believe general hospitals and specialized hospitals have been making greater use of multiport surgery. Still, many patients want single-port surgery. In this regard, I believe many of you will be curious about whether meerecompany’s Revo-i can be used for single-port surgery. I’ve thought much about this, too. And finally, I saw the potential of Revo-i being used for single-port surgery, and managed to prove it with a cadaver test in last October. Let me describe in more detail how single-port surgery using Revo-i is feasible.

The hospital I work at is owned by a Catholic foundation, so a sufficient amount of cadavers were supplied. In October, I attempted single-port surgery using Revo-i in the course of a training program using a cadaver. The first application of the attempt was vNOTES (vaginal natural orifice transluminal endoscopic surgery). The reason I chose vNOTES is that it provided a shorter distance to the surgical target compared to starting from the abdomen. Therefore, it’s more favorable for single-port surgery. Indeed, I found that single-port surgery was feasible. To expand the variety of surgical techniques, I can suggest “Single-port plus one.” This technique involves inserting a camera or surgical instrument into one hole and inserting an additional instrument to the left or right.

Firstly, I performed salpingectomy using the vNOTES approach. The vagina was widened with posterior colpotomy (vaginal incision), and once the abdominal cavity was identified, the wound retractor was inserted to secure the port. Then, the outer platform was inserted to make a path. The surgery proceeded while the fallopian tube was held with the dissector on the left hand and the monopolar curved scissors were applied with the right hand.

Next, I performed oophorectomy by approaching from the abdomen. In this case, the surgical target was farther than when using the vNOTES approach. Also, the roles of the left and right hands were reversed. In other words, the left hand (A Arm) used the monopolar curved scissors, and the right hand (B Arm) used the bipolar maryland forcep. Then, the left and right hands were switched in the software by manipulating touch screen of Revo-i master console. It means the instrument equipped on the left hand (A arm) was used with the right hand while the instrument equipped on the right hand (B arm) was used with the left hand. A retroperitoneal approach was used. If the process doesn’t go smoothly, then one instrument can be excluded and only one hand can be used for dissection. In this way, a single-arm surgery is feasible. A smoke might occur in the course of hemostasis but it’s well handled with suctioning by an assistant.

Foreign medical professionals who observed the surgery that day also practiced salpingectomy using Revo-i. Even a novice doctor with little experience in the laparoscopic surgery was able to proceed with the surgery using Revo-i under a skilled doctor’s coaching.

There are many surgical robots developed today. In addition to Intuitive Surgical, Stryker, Medtronic, and CMR Surgical, China and Japan are also developing surgical robots. I have visited the EBCOG where I found Medtronic’s HUGO and CMR Surgical’s Versius.

HUGO and Versius have a structural difference compared to Revo-i and da Vinci. Revo-i and da Vinci has 3 to 4 robot arms in one unit while HUGO and Versius have 3 and 4 robot arms designed as individual and separate devices. It’s similar to an industrial robot used for a factory. Also, with HUGO and Versius, the surgery is performed by wearing 3D glasses and watching the monitor, rather than directly checking the site. Additionally, there is a great difference in the joystick since it is not an intuitive controller. On the other hand, Revo-i is very similar to da Vinci in design.

Japan is also applying robotic surgeries and is expanding the insurance benefit for it. Japan previously did not approve the eligibility for insurance benefit until their own domestic surgical robot had been developed. It is the same situation in China. Likewise, CMR Surgical developed by UK is growing based on Europe. Every country is making efforts to develop its domestic robot.

Revo-i OBGYN cadaver workshop held in October

We are organizing the annual cadaver workshop, and it’s been held more than 10 times already. I’m happy with widely promoting new robotic surgery techniques using Revo-i through this workshop. Our aim for the future is innovation in the field of robotic surgery, of course. We need to recognize this and develop relevant techniques to contribute to patient treatment.