HYbrid RObotic Surgery in Urology (HYROS)

HYROS (HYbrid RObotic Surgery in Urology)

The HYbrid RObotic Surgery in urology (HYROS) study is an early feasibility clinical investigation of a new medical device under the commercial name of Bitrack System. Bitrack System is a surgical robot indicated to be used during urological surgical procedures. The Bitrack System also requires the specific single use of Electro-Surgical Endoscopic (ESE) instruments and Non-Electro Surgical Endoscopic (NESE) instruments.

The purpose of this clinical investigation is to evaluate the safety and feasibility of the Bitrack System and its corresponding ESE and NESE instruments in patients with the indication of a robot assisted laparoscopic radical/simple nephrectomy.

Study Overview

• Status: Completed
• Conditions: Nephrectomy
• Intervention / Treatment: Device: Bitrack System-assisted laparoscopic radical/simple nephrectomy

Detailed Description

The Bitrack System is a surgical robot indicated to be used during urological surgical procedures. This robot is intended to assist in the accurate control of endoscopic instruments and accessories for visualization and endoscopic manipulation.

Robotic Assisted Surgical (RAS) systems and equipment such as Bitrack System are intended for use in invasive surgical procedures, during which patients are potentially most vulnerable to physical harm. The Bitrack System comprises a console, a robotic unit, and embedded software.

The HYROS clinical investigation will be conducted as a single-center, early feasibility, and first-in-human (FIH) clinical investigation with a single arm, open-label, and non-randomized design, that will include 3 patients. This clinical investigation aims to evaluate the safety and performance of the Bitrack System in patients indicated with robotic-assisted laparoscopic Radical/simple nephrectomy surgery.

The planned visits for this clinical investigation are baseline (includes Screening, baseline visit, and Informed consent), procedure, discharge, 14-Days Follow-up visit, and 30-Days Follow-up visit (remote). The clinical investigation will include adult subjects (between 18 and 90 years old) who have been scheduled for laparoscopic radical/simple nephrectomy. The total duration of the clinical investigation is expected to be 4 months, consisting of approximately 3 months of enrollment plus 1 month of follow-up. The end of the clinical investigation will occur when the last visit of the last enrolled subject is completed.

• Study Type: Interventional
• Enrollment (Actual): 3
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Barcelona, Spain, 08036
    • Hospital Clinic De Barcelona

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult subjects between 18 and 90 years old
• Subjects must provide written informed consent prior to any clinical investigation related procedure
• Subjects who have been scheduled for a laparoscopic radical/simple nephrectomy surgery
• Ability and willingness to comply with all study requirements to be evaluated for each study visit

Exclusion Criteria:

• Pregnant or breastfeeding women at the time of the surgery
• Inability to adhere to study-related procedures
• Subject has known allergy to some of the device components (i.e., stainless steel, etc.)
• Subjects who participate in another trial which may affect the outcome data on this study or the ability to complete the follow-up requirements
• Subjects not suitable to undergo MIS (Minimally Invasive Surgery) /MIRS (Minimally Invasive Robotic Surgery), according to medical criteria
• Subjects with life expectancy inferior to 3 months
• Subjects with a Body Mass Index (BMI) ≥ 40
• Subjects with severe cardiopulmonary or coronary artery disease, bleeding disorders or that have been submitted to multiple prior operations
• Subjects with abuses of active substances or with uncontrolled psychiatric disorders
• Subjects scheduled for surgeries intended to be in direct contact with the heart, the central circulatory system or the central nervous system
• Subjects with any contraindication for the use of the Bitrack System and the ESE/NESE instruments, as specified in the Instructions For Use

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Device Feasibility
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Subjects to undergo laparoscopic radical/simple nephrectomy; Adult subjects between 18 and 90 years old, that provided informed consent prior to any clinical investigation-related procedure, who have been scheduled for a laparoscopic radical/simple nephrectomy surgery and who are able and willing to comply with all study requirements to be evaluated for each study visit.

Device: Bitrack System-assisted laparoscopic radical/simple nephrectomy; Robot-Assisted Laparoscopic Transperitoneal Radical/Simple Nephrectomy is performed under general anesthesia. Using blunt dissection, the inferior pole of the kidney is lifted, and ureter and gonadal veins released from fat and connective tissue. The ureter is dissected caudally and sectioned after being sealed with a distal endoscopic clip. Dissection proceeds along the psoas muscle with anterior elevation of the ureter and lower renal pole towards the hilium. Main hilar are circumferentially dissected and sectioned and the kidney is entirely mobilized and released. Gerota´s capsule and suprarenal gland may be preserved if oncologically safe. Once the specimen is completely released, a laparoscopic bag is introduced by the assistant and the specimen entrapped. The robot is undocked, gas evacuated from the abdomen and specimen retrieved.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety of the Bitrack System	Evaluation of the safety of the Bitrack System by measuring the occurrence of Procedure-Related Adverse Events (PRAEs) and Serious Adverse Events (SAEs) during the procedure and through the 30 days post-procedure period of enrolled patients indicated for robot assisted laparoscopic radical/simple nephrectomy. PRAEs are defined as any AE related to the investigational procedure.	30 days post-procedure
Performance of the Bitrack System	Evaluation of the performance of the investigational device by means of its ability to access and reach the target zone, perform all relevant surgical tasks and to be withdrawn efficiently without conversion to minimally invasive surgery (MIS) or open surgery. The performance of the Bitrack System and the ESE/NESE instruments is analyzed through the conversion rate to conventional laparoscopy/open surgery.	During the procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood Loss	Blood Loss defined as estimated mL of blood loss	During the procedure
Number of Participants With Adverse Events	All AE(s) events during the procedure and through the 14 and 30 days post-procedure were also assessed, including the assessment of the relationship with the investigational device and/or procedure by the principal investigator.	Procedure, discharge (up to one week post-procedure), 14 days and 30 days follow-up
Number of Participants With Absence of Tissue Damage	Individual safety is defined as absence of unwanted injure of any tissue for each instrument.	During the procedure
Individual Performance of Surgical Instruments	Individual performance is assessed by the Visual Analogue Scale (ranging from 0 to 10) following the subjective surgeon's opinion for each instrument surgical function, being 0 a non-functional tool and 10 an instrument that works exactly equivalent to the surgeon/s hands.	During the procedure
Transfusion Rates	Transfusion rate as the number of participants that required blood transfusion	During the procedure
Number of Participants That Require Hemostatic Agents.	Number of participants that require the use of hemostatic agents.	During the procedure
Operative Time Procedure	Operative Time Procedure (or Surgical Procedure Time) includes the time spend to perform the set of all the different tasks completed during the surgical procedure. It is defined from first ESE/NESE instruments docking to the conversion to gestural mode for their final withdrawal.	During the entire surgical procedure
Post-operative Pain	Evaluation of the post-operative pain in patients through the Cumulative Analgesic Consumption Score (CACS) during the first week (7days) post-procedure. To calculate the CACS score, information on the number of single analgesic doses (n) and their classification on the WHO pain relief ladder was collected. The WHO pain relief ladder ranges from I to III: step I (nonopioids): acetaminophen, ibuprofen or metamizole;; step II (opioids for mild to moderate pain): tramadol, tilidine/naloxone;; step III (opioids for moderate to severe pain): piritramide, pethidine, oxycodone or morphine. The Cumulative Analgesic Consumption Score (CACS) is calculated by adding all (n), multiplied by the level of the WHO pain relief ladder. Since the lenght of stay was shorter (2-3 days), it was not possible to collect the analgesic consumption up to 7 days after patient hospital discharge.	Day 1 and Day 2 post-procedure
Length of Stay (LoS) in Hospital	Assessment of the duration of subject's hospitalization as the Length of Stay (LoS) in hospital calculated from day of admission to day of discharge.	Discharge (up to one week post-procedure)
Patient Pain Assessment	Patient pain assessment via Visual Analog Score (VAS) for pain on a scale from 0 ('no pain') to 10 ('pain as bad as it could possibly be').	Discharge (up to one week post-procedure), 14- and 30-days post-procedure
Post-procedure Complication Rates - Comprehensive Complication Index (CCI)	Post-procedure complication rates assessment by measuring the Comprehensive Complication Index (CCI) on a scale from 0 (no complications) to 100 (death).	Discharge (up to one week post-procedure),14 and 30 days follow-up
Post-procedure Complication Rates - Clavien-Dindo Classification	Post-procedure complication rates assessment by the Clavien-Dindo classification, which consists of 7 grades (I, II, IIIa, IIIb, Iva, Ivb and V), the first one (I) indicating any deviation from the normal postoperative course and the highest (V) corresponding to death.	Discharge (up to one week post-procedure),14 and 30 days follow-up

Collaborators and Investigators

• Sponsor: Rob Surgical Systems S.L.
• Investigators: Principal Investigator: Lluis Peri Cusi, MD, Hospital Clinic of Barcelona

Study record dates

Study Major Dates

• Study Start (Actual): April 11, 2023
• Primary Completion (Actual): May 30, 2023
• Study Completion (Actual): May 30, 2023

Study Registration Dates

• First Submitted: April 3, 2023
• First Submitted That Met QC Criteria: May 8, 2023
• First Posted (Actual): May 18, 2023

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 17, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Laparoscopy; Simple; Radical
• Other Study ID Numbers: PL-PR01-027

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No