Abstract
OBJECTIVE: Rigid suction-coagulation probes constrain the wrist-like articulation that is central to robotic surgery. We therefore designed a 5-mm single-use flexible suction ball coagulator (flex-SBC) with a modified core design to restore dexterity and assessed its mechanical performance and early clinical feasibility, including the effect of the common robotic gripping strategies on suction flow. METHODS: Preclinical. The new 7 × 7 core embedded in silicone was compared with the conventional 1 × 7 core design. Shaft pliability was quantified by sagging displacement and rebound force testing. Suction flow at - 20, - 30, and - 40 kPa was measured, and the impact of grip location (electrode base vs silicone shaft) and forceps type (fenestrated or Maryland bipolar) was analyzed statistically. CLINICAL: The flex-SBC was used in 12 consecutive robotic gastrectomies with prospective collection of device performance, adverse events, and surgeon rating on seven-domain via three-point Likert scale. RESULTS: Preclinical. Adopting the 7 × 7 increased mean sagging displacement from 15.6 ± 1.8 to 39.3 ± 3.2 mm (p < 0.001) and reduced rebound force from 0.288 ± 0.014 to 0.059 ± 0.004 N (p < 0.001). Mean flow rates were 6.76 ± 0.88, 8.87 ± 0.43, and 10.58 ± 0.40 mL/sec at - 20, - 30, and - 40 kPa, respectively-approximately half those of a rigid probe (all p < 0.001) but still exceeding published thresholds for effective evacuation. Gripping the silicone shaft, especially with Maryland forceps, sharply reduced flow (60% reduction; p < 0.0011). CLINICAL: All operations were completed without device-related malfunctions, injuries, or conversions. Of 84 survey ratings, connection setup, suction efficiency, tissue safety, and overall satisfaction were "satisfactory" in 100%; maneuverability was "satisfactory" in 65% and "average" in 35%. No "unsatisfactory" scores were recorded. CONCLUSIONS: The flex-SBC bends where the robot bends, enabling safe, practical use across robot-assisted upper-GI surgery. Grip technique influences device performance, providing important implications training. Larger comparative trials should clarify whether these ergonomic gains translate into shorter operating times and improved oncologic precision.