Vall d’Hebron performs Europe’s first paediatric surgery using a single-incision robot

Sixteen years ago, Vall d’Hebron University Hospital introduced its first surgical robot into its operating theatres. It was used to operate on a girl with an ovarian tumour. That procedure became the first robotic surgery performed by a Paediatric Surgery department in Europe and marked the beginning of a new era in minimally invasive paediatric surgery. Since then, the technology has evolved and the first devices, originally developed by NASA, have given way to systems that are more precise, flexible and less invasive. Now, Vall d’Hebron is once again at the forefront in Europe with a new milestone. The Paediatric Urology and Renal Transplantation team, part of the Paediatric Surgery Department, has performed Europe’s first paediatric surgery using a single-port surgical robot: a nephroureterectomy on a twelve-year-old boy whose kidney and ureter had to be removed after an infection caused by multiple stones, some as large as a cherry, rendered the organ non-functional.

Unlike conventional robotic systems, which use four arms and require several incisions to introduce the camera and surgical instruments, the new robot operates through a single arm and accesses the body through a single incision. Through this opening, the camera and surgical instruments are introduced and then unfold inside the body, operating independently with a wide range of motion and flexibility that allows surgeons to reach anatomically confined spaces. As a result, patients experience less pain and recover faster.

The new robotic platform is the SHURUI Single Port (SP) system, developed by the Chinese company Surgerii Robotics, which has chosen Vall d’Hebron as the entry point for this technology in Europe. The Single Port-Snake technique is designed to simplify surgical procedures. The system works through a single access point through which both the camera and the continuum-bending surgical instruments are introduced. It also provides a 360-degree field of vision. Its flexibility preserves the advantages of multi-port robotic platforms while simplifying surgical access and enabling manoeuvres with a level of precision that is difficult to achieve with the human hand.

The device holds CE marking for clinical use in both adult and paediatric patients, certifying compliance with all European requirements for safety, effectiveness and quality. “It is currently the only single-port robotic surgical system approved by the European Union and indicated for paediatric procedures”, says Dr Albert Salazar, Managing Director of Vall d’Hebron University Hospital. “Its incorporation is another step forward in building the New Vall d’Hebron, a more modern and sustainable hospital”, he adds. “This first installation at Vall d’Hebron represents an important milestone for Surgerii Robotics”, says Professor Kai Xu, CEO of the company.

A nephroureterectomy in a twelve-year-old boy, the first procedure
The Departments of Paediatric Surgery, Urology, and General and Digestive Surgery, which is expected to perform the highest number of procedures, are already using the robot. Its introduction at Vall d’Hebron has been made possible by the hospital’s extensive experience in robotic surgery. The new platform will enable between 200 and 300 additional robotic procedures per year and support increasingly complex operations.

Despite their name, surgical robots do not operate autonomously. The surgeon controls the procedure from a console located outside the sterile field. From there, they have a three-dimensional view of the patient's anatomy, magnified up to ten times, and manipulate the instruments with millimetric precision.
“For healthcare professionals, these systems provide greater precision, allow access to confined spaces and make complex procedures less physically demanding by eliminating factors such as tremor and postural fatigue”, explains Dr Marino Asensio, Head of Paediatric Urology and Renal Transplantation. “For patients, the benefits are numerous: less bleeding, fewer complications, less postoperative pain, shorter hospital stays, faster recovery and better cosmetic outcomes, all of which are particularly important in paediatric surgery”, he adds.

In this first paediatric procedure, a multidisciplinary team involving Anaesthesiology, Nursing and the Paediatric Urology and Renal Transplantation section, led by Dr Marino Asensio, operated on a twelve-year-old boy under the care of Dr Glòria Royo, consultant surgeon in the department. “We were able to remove the kidney and ureter, which had become infected and non-functional due to multiple stones, some measuring more than 3 cm”, explains Dr Glòria Royo. "This single-port surgical system enabled us to remove the kidney and the entire ureter through a single incision, thanks to the system’s 360-degree manoeuvrability", she adds.

Vall d’Hebron is a referral centre for robotic and highly complex surgery across multiple specialties. In paediatric urological surgery, it is the only hospital in Spain with an uninterrupted paediatric robotic surgery programme and has performed more than 200 procedures. As a referral centre, Vall d’Hebron holds 50 CSUR accreditations, 20 European Reference Network (ERN) designations and 12 Clinical Expertise Unit Network (XUEC) accreditations, enabling it to treat patients from across Spain.

“The installation opens up new opportunities for clinical collaboration, training and knowledge exchange between Vall d’Hebron and Surgerii Robotics as single-port robotic surgery becomes more widely adopted in Europe”, says Dr Albert Salazar. Professor Kai Xu adds, “It is an honour to collaborate with Vall d’Hebron and continue supporting surgeons as they explore the clinical applications of single-port robotic surgery across various specialities, including paediatric procedures”.

The benefits of this new system also extend to hospital operations. Vall d’Hebron now has four robotic operating theatres: three multi-port and one single-port. “The hospital currently performs close to 1,000 robotic procedures every year, and this new system will allow us to increase activity by between 200 and 300 procedures annually”, says Dr David Virós, Chair of the Robotic Surgery Committee and Head of the Ear, Nose and Throat and Head and Neck Surgery Department. “It also contributes to a more efficient use of healthcare resources, as this type of surgery is associated with fewer complications, shorter hospital stays and reduced need for pain management”, he adds.

For the General and Digestive Surgery team, the new system opens up new possibilities, particularly for complex hepatobiliary, pancreatic and colorectal procedures, where the combination of precision and minimal invasiveness may improve patient recovery. 

For paediatric and surgical nursing teams, the introduction of the robot represents both a challenge and an opportunity to continue improving quality of care. Their role is essential in preparing the surgical environment, adapting equipment to the needs of paediatric patients and coordinating the multidisciplinary team, while also ensuring close support for children and their families throughout the care process.

A disruptive technology programme to build the New Vall d’Hebron
The SHURUI SP system is part of the ‘New Digital Technologies for the Personalised Management of Congenital and Complex Conditions (3Dx3C)’ programme, funded by the European Union’s STEP Fund to develop disruptive digital solutions (3D) for the care of congenital and complex conditions (3C). One of its key capabilities is the integration of digital twins, virtual replicas of patients’ organs and/or clinical procedures that enable surgical planning, scenario simulation, and intraoperative support for surgeons through augmented reality tools.