REVO

Editor’s Note: Since the introduction of the Korean-developed Revo-i surgical robotic system at Severance Hospital in 2023, it has been actively utilized in various surgical procedures, primarily in urology and general surgery, leading to the completion of 100 successful cases. To commemorate this milestone, this symposium summarizes the background, achievements, and real-world applications of Revo-i not only at Severance Hospital but also in secondary hospitals that have adopted the system.

<Session I: Complex Robotic Surgery with Revo-i Robotic Surgical System>

1. Yonsei Revo-i HBP Surgery – Past, Present, and Future (Prof. Chang Moo Kang, Department of Surgery, Yonsei University College of Medicine)

2. Colorectal Surgery Experience (Prof. Byung Soh Min, Department of Surgery, Yonsei University College of Medicine)

3. Introduction and Practical Use of the Revo-i System in Urology (Prof. Jongsoo Lee, Department of Urology, Yonsei University College of Medicine)

Chair: Koon-Ho Rha, Director, NAVER Healthcare Research Institute

Introduction and Practical Use of the Revo-i Surgical System in Urology (Prof. Jongsoo Lee, Department of Urology, Yonsei University College of Medicine)

My first encounter with meerecompany’s Revo-i robotic surgery dates back to my residency training. At the time, Dr. Koon-Ho Rha was conducting clinical trials and performing robot-assisted prostatectomies, boldly incorporating the Retzius-Sparing technique—a highly advanced surgical method aimed at preserving function. Due to its complexity, most surgeons were reluctant to attempt this approach, yet Dr. Rha successfully executed the procedure, demonstrating Revo-i’s potential and capabilities.

In 2023, I had another opportunity to engage with Revo-i robotic surgery once again during a four-nation robotic surgery training exchange in Uzbekistan, which included participants from the U.S., Russia, Korea, and Uzbekistan. Live demonstrations showcased robot-assisted prostatectomies and partial nephrectomies using Revo-i. This experience inspired me to share my own expertise and further advocate for Revo-I’s efficiency and potential, just as I had gained confidence from observing others. My goal is to support the adoption and advancement of robotic surgery through shared knowledge and continuous development.

The first case in which I personally utilized Revo-i was a partial nephrectomy, with the possibility of conversion to a radical nephrectomy in mind. The patient was a young female with a relatively small tumor, making a partial nephrectomy a viable option. However, during the biopsy, the tumor enlarged from 11 cm to 13 cm due to bleeding and infection, significantly increasing the complexity of the procedure. Despite these challenges, the surgery was successfully completed, and pathological examination confirmed a 13.5 cm malignant tumor. A 10-month follow-up scan showed the patient was in good condition. A comparison of surgical outcomes and recovery between Revo-i and foreign robotic systems revealed no significant differences—both patient groups maintained stable kidney function, with no meaningful variations in pre- and post-operative creatinine levels or glomerular filtration rate (GFR).

As of December 6, 2024, I have performed approximately 34 procedures using Revo-i, the majority being partial nephrectomies. My primary focus on partial nephrectomy stems from the fact that Revo-i’s feasibility in performing prostatectomies, including complex techniques, has already been well established. Additionally, an analysis of Severance Hospital’s robotic surgery data shows a shift—while prostate surgeries once dominated, kidney surgeries have now become more prevalent. This trend is likely due to advancements in diagnostic techniques and increased early detection, as kidney cancer remains among the top 10 most commonly diagnosed cancers. As a result, I chose to concentrate on kidney surgery, aiming to further validate Revo-i’s utility in this field.

Kidney surgery is highly time-sensitive, as prolonged ischemic time can impact renal function. Therefore, procedures must be performed as quickly and efficiently as possible. This provided an opportunity to evaluate Revo-i’s mobility and operational efficiency. Additionally, since suture work is essential in kidney surgery, the system’s joint articulation and maneuverability were also assessed. Most notably, when comparing Revo-i with other robotic surgical systems, there was no significant difference in overall ischemic time. Similarly, renal score-based performance assessments showed only minimal variance between the systems. Furthermore, as more surgical cases accumulated, procedure times steadily decreased, demonstrating a positive learning curve for Revo-i.

I have prepared multiple videos showcasing no significant differences in mechanical movement and procedural execution between the two systems. In kidney tumor surgery, the complexity is largely determined by tumor location and its proximity to blood vessels. For instance, tumors positioned close to the renal artery or renal vein require high precision to avoid vascular damage during surgery. In such cases, the robotic system’s accuracy is critical, and Revo-i successfully handled these complex procedures. One such case, shown in the upper right video, involved a tumor located directly above the renal artery and renal vein. Despite this challenging positioning, Revo-i’s stability and precise controls allowed for a successful operation without vascular injury.

In some cases, tumor removal is performed without clamping the blood vessels (off-clamp approach) to minimize ischemic time. This method may result in minor bleeding, but when managed swiftly, it serves as a viable alternative. In a case involving a 4 cm tumor, the off-clamp approach was applied, and the tumor was successfully removed without major complications, demonstrating Revo-i’s precise handling of vascular structures.

The bottom-right video highlights a kidney cancer case where the tumor extended into the inferior vena cava (IVC). This is one of the most complex procedures in robotic surgery, as it involves tumor resection along with the IVC. In this case, Revo-i was utilized to perform an extended arterial dissection, allowing for successful excision and transfer of the tumor. Both the recipient and donor patients remain in stable condition to date.

As demonstrated in various procedures, Revo-i, developed by meerecompany, has consistently proven to be a stable and reliable surgical system. A key takeaway from my experience is that rather than comparing it to luxury vs. commercial vehicles, a more fitting analogy is the distinction between internal combustion engine (ICE) and electric vehicles (EVs). Because the two systems operate on fundamentally different mechanics, they provide distinct experiences. Surgeons accustomed to conventional robotic systems may initially find Revo-i’s handling unfamiliar, much like a driver transitioning from an ICE vehicle to an EV. However, as with any new system, adaptation comes with time and experience. Recently, new surgical approaches utilizing Revo-i have been explored to optimize procedures and minimize patient trauma.

For instance, in a partial nephrectomy that required access from beneath the liver to below the bladder, a broad surgical field was necessary. Given this challenge, the procedure was efficiently performed using only two robotic arms. The left arm was primarily used for upper kidney work, while the right arm was utilized for lower kidney procedures. During the lower bladder region of the nephrectomy, the positioning of the robotic arms was adjusted accordingly. Initially, the left and right arms were used in their standard positions, but as the procedure moved downward, their roles were swapped, with the left arm repositioned to the right side and vice versa. This adjustment minimized interference and allowed for the smooth execution of delicate tasks. As the procedure progressed, the ureter was carefully dissected, and the bladder was successfully sutured, confirming that Revo-i is highly effective even in wide-ranging surgical fields.

A cost-effectiveness comparison between Revo-i and other robotic systems was also conducted. The findings indicated that hospitals with lower surgical volumes experience greater financial disparities between different systems. For example, hospitals performing around 50 robotic surgeries per year may find it challenging to recover costs if they invest in high-priced robotic systems. Ultimately, adopting a robotic surgical system should not be based solely on technical performance—it requires a comprehensive economic assessment that considers the hospital’s annual surgical volume and operational scale. In this regard, Revo-i offers a flexible and practical alternative, making it a viable solution for a variety of institutional needs and financial constraints.

Korean Article: https://www.whosaeng.com/158430