New Robotic Surgical Systems in Urology: An Update

Theodore Cisu; Fabio Crocerossa; Umberto Carbonara; Francesco Porpiglia; Riccardo Autorino


Curr Opin Urol. 2021;31(1):37-42. 

In This Article


Initially developed by a Milan-based healthcare company (Sofar), the Telelap ALF-X system was acquired by Transenterix (Morrisville, North Carolina, USA) in 2015. It was then renamed as the 'Senhance' surgical system and received FDA approval in October 2017 for laparoscopic abdominal procedures, representing the only market-cleared competitor with Intuitive Surgical in the United States ( The system was designed to 'digitize laparoscopic minimally invasive surgery' by integrating the precision of robotic arms with haptic feedback and an infrared 3D eye-tracking system in an open console configuration ( Instead of an operation cart, Senhance has up to four independent robotic arms that can hold reusable laparoscopic instruments. The surgeon sits upright in a chair with two handles, has views of the monitor as well as of the operating room, and uses polarized glasses to interact with the 3D-HD-screen. As of March 2020, Transenterix received 510(k) FDA clearance for its 'machine vision system', which is a personal digital assistant for surgeons, and will automatically move the camera for a surgeon based on instrument movements and recognition of learned landmarks in the field of view ( This is a form of augmented intelligence that will learn how the surgeon approaches their cases and help to standardize those methods, providing both a convenience and a safety feature for console operators.

Initial clinical reports emerged in the gynecologic and general surgery literature but increasing interest from the urologic community has resulted in two single-site experiences in Lithuiania and Croatia demonstrating feasibility and clinical efficacy for robotic prostatectomy[5–7] (Table 2). Early user data suggests that the haptic feedback was beneficial in the handling of tissue, and that the seated position proved to be more ergonomically favorable compared with current robotic systems; however, its lack of articulating instruments was disadvantageous.[7]