Safety and feasibility of solo surgery using a novel robotic platform: an IDEAL 2a development study.

BACKGROUND

Minimally invasive surgery is the standard of care for general surgical procedures. While use continues to grow, current platforms are hindered by prolonged operative times, high costs, steep learning curves, and lack of surgeon autonomy, which restricts expansion and practicality in high-volume and ambulatory surgery centers. Our goal was to evaluate the safety and feasibility of a novel AI-powered robotic platform to perform solo surgery.

METHODS

An IDEAL framework 2a prospective, multi-center observational study was performed on consecutive patients planned for solo abdominal surgery using the Maestro™ robotic system (Moon Surgical SAS, Paris, France) from 10/2023 to 4/2025. Preoperative, intraoperative, postoperative, and device-specific variables were evaluated. Descriptive statistics were used to summarize outcome measures.

RESULTS

Forty-five procedures were performed by five surgeons. Patients had a mean age of 55.3 (SD 18.1) years and a mean BMI of 29.4 (8.1) kg/m2. The cohort was 1/3 male and 2/3 female. The main indications for operation were cholecystitis (n = 17, 37.8%), obesity (n = 10, 22.1%), and inguinal hernia (n = 11, 24.4%). The most common cases were cholecystectomy (n = 17, 37.8%), inguinal hernia (n = 11, 24.4%), and sleeve gastrectomy (n = 5, 11.1%). The mean total room time was 95.5(SD 38.3) minutes, the mean operative time was 43.6(SD 30.6) minutes, and the mean robotic setup time was 6.1(SD 4.1) minutes. One case required conversion to multiport laparoscopy (2.2%). No cases required insertion of additional ports or a bedside assistant. The mean length of stay was < 1 (SD 1.3) day. There was minor morbidity in 3 (6.6%) patients, but no readmissions, reoperations, or mortality. There were no device-related adverse events.

CONCLUSION

This IDEAL 2a investigation showed the Maestro platform was safe and feasible for performing solo surgery, with acceptable safety and technical outcomes in routine and complex procedures. There is potential to improve operating room workflow and surgeon autonomy, with controlled studies to follow.