Versius surgical system: tips and tricks for OR setting and port placement for pelvic surgery, our experience in a multi-robotic referral centre

Background: The Versius surgical system (CMR Surgical, Cambridge, UK) is a new robotic platform introduced after the original patent of the DaVinci system expired; it has already been applied in different fields, including gynaecology. Unlike DaVinci, Versius has four independent bedside units (BSU), which must be individually positioned with adequate angles and distance to avoid collisions. Given this peculiarity and the shorter arm (30 cm) compared to the Da Vinci, investigating BSU positioning and port placement is mandatory. We aim to report technical tips and tricks for OR setup and port placement by analyzing our initial series with the Versius system for benign gynaecological conditions, thereby making the procedure easily reproducible. Materials and methods: We considered prospectively 19 patients undergoing robotic surgery for gynaecological diseases. Demographics, pre-surgical variables, intraoperative robotic events (number and characteristics of collisions, need for detaching instruments, and moving trays during surgery), and perioperative outcomes were collected. Factors impacting the occurrence of high-impact collisions (requiring the disconnection of instruments and restarting of the port training) were analyzed. Result: All surgeries were carried out uneventfully and without conversion. Collisions of any type occurred in 16 out of 19 operations, including 11 high impact collisions. The distance between the trocars and the target organ is a factor that impacts the necessity to restart the system. Conclusions: Versius appeared to be a safe option for benign gynaecological surgery. Our experience suggests that a minimum distance of 19 cm from the bipolar operative trocar and the target organ, as well as a minimum distance of 15 cm between the scissors operative trocar and the target organ, is recommendable to avoid any collisions, or 11 and 9 cm to avoid high impact collisions. Conclusions: Versius appeared to be a safe option for benign gynaecological surgery. Our experience suggests that a minimum distance of 19 cm from the bipolar operative trocar and the target organ, as well as a minimum distance of 15 cm between the scissors operative trocar and the target organ, is recommendable to avoid any collisions, or 11 and 9 cm to avoid high impact collisions.