Table 4

Iterations and modifications to the Sirius System

Case no.ProcedureLessons learnt/improvement Notes
1.Total laparoscopic hysterectomy bilateral salpingo-ophorectomy (SILS)>Endoscope Inner packaging did not show the expiry date information. Resolved by providing additional documentation, and all new batches were made to comply to hospital standard.
>During setup it was unsure that the connector was connected, until assisted by a Precision Robotics engineer. An improvement was made to the connector subsequently (figure 2).
2.vNOTEs hysterectomy bilateral salpingo-ophorectomy>SIRIUS Endoscope was used with supporting documents to ensure sterility.
>Though the image quality was sufficient to complete the surgery, the image was noted to be too red.
3.Total laparoscopic hysterectomy left salpingo-ophorectomy, right salpingectomy (multiport)>Scope insertion diameter tip was found to be slightly >10 mm while trying to insert it into a reusable trocar, and it was found that the diameter was actually 10.6 mm. As such, the trocar was replaced with a 12 mm disposable trocar for the endoscope.
>Articulated bending was useful, but there was no indication on the screen of the position of the tip.
4.Total laparoscopic hysterectomy bilateral salpingo-ophorectomy (SILS)>Camera head was found to be defective, and an investigation was initiated subsequently. The root cause of the fault was found to be the incorrect connection of the protective earth of the laparoscope head. All the camera heads from the same batch (008) were recalled. New batches were manufactured, and additional tests were carried out to ensure the same issues would not recur.
5.Laparoscopic right ovarian cystectomy (SILS)>Endoscope label improvement with new endoscope production Batch (011).
>Software updates: Dynamic model/additional color mode (2 and 3)/connector connection label/single camera functional fix. (figures 2–4).
>Grounding issues electrical hardware improvement/testing.
6.vNOTEs hysterectomy bilateral salpingo-ophorectomy>Surgeon noted that after gaining more experience of the Sirius System, the assistant nurse was able to use the articulated tip to follow and center the surgeon’s operating field without moving the endoscope. This could facilitate vNOTEs and SILS procedures, where instrument clashes with conventional rigid endoscopes were one of the main hindrances.
>Trial on the different color mode settings: Mode 1—normal (more realistic)/Mode 2—enhance sharpness (difference was noticeable)/Mode 3—hue shift to blue (color of the image looked unrealistic and therefore further improvement is required).
7.Total laparoscopic hysterectomy bilateral salpingo-ophorectomy (SILS)>Image quality was good and clear, until there was blood, when the image became too red.
>Assistant nurse was not familiar with the use of the joystick and caused some issues stressing the importance of the learning curve. Overall, the articulated tip helped to avoid collision with other instruments.
8.Left ovarian cystectomy (SILS)No issues.
9.Total laparoscopic hysterectomy bilateral salpingo-ophorectomy and bilateral pelvic lymphadenectomy (multiport)Image was too red and required setting the color mode to 3 to continue.
10.Laparoscopic bilateral ovarian cystectomy (SILS)Image glitch occurred when using the scope, and it required a change to another Sirius scope. The subsequent investigation found that this was due to the scope head inadvertent mechanical disconnection.
11.Total laparoscopic hysterectomy bilateral salpingo-ophorectomy and bilateral pelvic lymphadenectomy (multiport)Endoscope batch implemented with true 10 mm diameter—production batch (012).
12.Laparoscopic myomectomy (SILS)No issues. It was noted that the single-use disposable laparoscope ensured sterility, and no downtime for sterilization in between cases 8, 9, and cases 11, 12, which were conducted one after the other.
13.Laparoscopic left ovarian cystectomy (SILS)No issues.
  • SILS, single incision laparoscopic surgery; vNOTEs, vaginal natural orifice transluminal endoscopic surgery.