Initial experience with “Saroa” in radical prostatectomy: A novel surgical assist robot featuring tactile feedback and a roll clutch system

Initial experience with “Saroa” in radical prostatectomy: A novel surgical assist robot featuring tactile feedback and a roll clutch system | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Initial experience with “Saroa” in radical prostatectomy: A novel surgical assist robot featuring tactile feedback and a roll clutch system Kosuke Iwatani, Fumihiko Urabe, Shun Saito, Shota Kawano, Tomoya Yamasaki, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4344298/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Dec, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Objectives Robotic surgical systems have revolutionized laparoscopic surgery, offering enhanced articulation, dexterity, and precision for complex procedures, such as radical prostatectomy. Although these systems enable surgeons to operate more intuitively, the risk of injury and hemorrhage from excessive force during tissue retraction remains a concern. Methods We enrolled 31 patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) using either the Saroa or da Vinci Xi surgical system at our hospital between January 2022 and January 2024. Perioperative complications and pathological outcomes were compared using the Mann-Whitney U and chi-square tests. Results No significant differences in preoperative demographics were observed between the systems. Operation times were longer using Saroa, but significant differences were not observed between the systems in terms of pathological outcomes, urinary continence, and postoperative complications. Conclusions This is the first study to evaluate the effectiveness and safety of the Saroa surgical system for RARP. This system incorporates several innovative features, such as a roll clutch system and tactile feedback, which enhance precision and workflow in minimally invasive surgery. The tactile feedback may benefit surgeons with limited laparoscopic experience, promoting gentler tissue handling. Further investigation is warranted to assess long-term oncological and functional outcomes following RARP with Saroa. Robot-assisted radical prostatectomy sense of tactile Japanese surgical robot Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Robotic surgical systems have revolutionized laparoscopic surgery, offering enhanced articulation, dexterity, and precision for complex procedures, such as radical prostatectomy. 1 These systems enable surgeons to operate more intuitively, with reduced endoscope tremors and enhanced accuracy. 2 However, the risk of injury and hemorrhage associated with excessive force during tissue and organ retraction remains a concern. 3 Therefore, a novel robotic system known as Saroa (Riverfield Inc., Tokyo, Japan) has been developed (Fig. 1 ). Saroa has a compact design with three pneumatically powered arms that directly transmit the tactile sensation of forceps pressure to the surgeon; moreover, it incorporates a unique roll clutch system for effortless wrist control. Although it has demonstrated utility in colorectal cancer resection, 4 our study is the first to evaluate its effectiveness and safety in robotic-assisted laparoscopic radical prostatectomy (RARP). We compared the perioperative outcomes of RARP between Saroa and the da Vinci (Intuitive Surgical, Sunnyvale, CA, USA) surgical systems. Methods We enrolled 55 patients who underwent RARP using Saroa (n = 7) or da Vinci Xi (n = 48) at Jikei University Kashiwa Hospital between January 2022 and January 2024. Procedures were performed by KI and JM (experience with > 50 da Vinci Xi cases). The da Vinci Xi system was used between January 2022 and July 2023, and Saroa was used between August 2023 and January 2024. We excluded 24 cases that involved lymphadenectomy or lacked perioperative data. A single pathologist assessed all prostate specimens. Postoperative continence was defined as requiring 0–1 security pads per day. The Institutional Review Board of the Jikei University School of Medicine [No. 35–398(12035)] approved the study protocol. RARP using Saroa was performed after obtaining approval from the Highly Difficult Technology Committee and the Medical Safety Committee at our hospital, and informed consent was obtained from all participants. Surgical Procedure RARP was performed in a 25° head-down supine position (da Vinci system) or the lithotomy position (Saroa Surgical System). The shorter forceps in the Saroa system necessitated the placement of the camera port below the umbilicus, with lateral ports arranged in a diamond configuration (Fig. 2 ). We used ERBE VIO 300 D (ERBE USA, Marietta, GA) and Valleylab™ FT10 (Medtronic, Minneapolis, MN, USA) electrosurgical generators (Fig. 3 ). We used a trans-peritoneal approach with bladder neck preservation. Nerve-sparing decisions followed thorough patient consultation. Vesicourethral anastomosis was performed using continuous 3–0 Stratafix (Covidien, Mansfield, MA, USA) sutures. Statistical Analysis Patient background and perioperative outcomes were compared using the Mann-Whitney U and chi-square tests. Statistical analyses were performed using R software (version 4.20, R Foundation for Statistical Computing, Vienna, Austria). P-values < 0.05 were considered statistically significant. Results Treatment Outcomes Table 1 presents the baseline characteristics of the study participants. No significant differences were observed between the groups in preoperative demographics, such as patient age, body mass index, baseline serum levels of PSA, and prostate volume. Table 2 summarizes the perioperative outcomes. Nerve-sparing procedures were performed in 12 patients (50%) in the da Vinci group. The Saroa group demonstrated significantly longer operative and console times (median operative time: 273 [257–294] min vs. 218 [189–230] min, P < 0.001; median console time: 195 [191–231] min vs. 136 [121–162] min, P < 0.001). No significant differences were found in other surgical outcomes, including estimated blood loss, intraoperative blood transfusion, intraoperative complications, or major postoperative complications (defined by the Clavien-Dindo classification). Surgical positive margin rates and other pathological outcomes were similar between the groups. Urinary continence at 3 months postoperatively did not differ significantly (71.4% vs. 87.5%, p = 0.665). Surgical feasibility The Saroa system integrates novel features, including tactile feedback and a roll clutch system. We measured the grasping force exerted by the robot on organs with and without tactile feedback. Tactile feedback significantly reduced the overall force, indicating that surgeons may apply excessive force without this sensory input (Fig. 4 ). In addition, force measurements with equal forceps closure revealed significant differences between the bladder and prostate (Fig. 5 ), emphasizing the inherent difficulty of visually differentiating tissue boundaries. The roll clutch system proved essential for suturing, enabling deep stitches without re-holding the needle. The clutching mechanism minimized force on the puncture site during needle repositioning (Fig. 6 ). Discussion Robotics-assisted surgery offers several advantages, including tremor reduction, enhanced precision, shorter learning curves, and improved surgical and oncological outcomes. 5 – 7 Robotic surgery has significantly impacted radical prostatectomy, combining the advantages of open and laparoscopic techniques while enabling precise manipulation at the pelvic floor. We evaluated the effectiveness and safety of Saroa, a novel surgical assistant with tactile feedback, in RARP. Recent advancements in surgical robots prioritize replicating the dexterity of surgeon hand movements during minimally invasive procedures. 8 , 9 However, tissue damage caused by excessive force during organ manipulation remains a critical concern. The Saroa system addresses this challenge by incorporating tactile feedback, allowing surgeons to perceive resistance while grasping. This is particularly beneficial for surgeons with limited laparoscopic experience, allowing gentler tissue handling. 10 Although a firm grasp may be necessary for certain instruments, such as needles, this can lead to finger fatigue. Notably, the grasping force required differs significantly between prostate and bladder tissues (Fig. 4 ); this emphasizes a key advantage over the da Vinci system, which primarily relies on visual cues for bladder neck dissection. Using Saroa, the bladder neck can be recognized using visual and tactile feedback. This dual-sensory approach could broaden its utility in various surgeries. Furthermore, the ability to determine the exact dissection plane through tactile grasping may help surgeons perform higher-quality surgeries. Saroa incorporates several innovative features designed to enhance precision and workflow in minimally invasive surgery. One key feature is a roll clutch system that facilitates highly precise needle movements, particularly during deep, delicate insertions. Unlike conventional robotic platforms with limited arm rotation, Saroa permits continuous needle driving, minimizing tissue damage. This enhanced control improves needle handling and allows surgeons to perform a wider range of surgical maneuvers. Furthermore, its open console design promotes better communication between the operating surgeon and the surgical team, enabling multiple surgeons to visualize the procedure simultaneously in 3D. In our study, the operation took longer using Saroa. This might be attributable to the unfamiliarity of surgeons with the system vs. da Vinci Xi and the absence of a fourth robotic arm. The fourth arm plays a crucial role in procedures such as RARP, which provides necessary tension on pelvic floor organs. This function must be performed by an assistant surgeon when using Saroa, increasing operation time due to reduced coordination in early robotic surgeries; however, surgeon–assistant coordination is improving with practice. Moreover, plans are underway to introduce two more arms. However, the current three-arm design offers advantages in weight and size, simplifying installation in operating rooms of varying dimensions. Furthermore, its compatibility with standard endoscopes, trocars, and equipment significantly reduces operating costs compared to conventional systems. Our study is the first to evaluate the effectiveness and safety of Saroa in RARP. Although surgeons experienced in robotic surgery performed the procedures safely, operative times were slightly extended. Further investigation is warranted to assess long-term oncological and functional outcomes following RARP with Saroa. Abbreviations RARP: Robot-assisted radical prostatectomy Declarations Acknowledgments We thank RIVERFIELD Inc. for equipment coordination and development, the doctors at Abiko Toho Hospital (KF, HO, TO) for their cooperation, and the Jikei University Kashiwa Hospital staff for their study assistance. In addition, we thank Textcheck Inc. for English language editing. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests This study was conducted using the Saroa surgical system, which was provided by RIVERFIELD Inc. under a time-limited loan agreement for clinical usage purposes. RIVERFIELD Inc. did not provide any funding or other benefits related to this research. The authors have no any other relevant financial or non-financial interests to disclose. Author Contributions K.I. designed the study and wrote the initial draft of the manuscript. All other authors contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Approval of the research protocol by an institutional reviewer board The Ethics Committee of the Institutional Review Board of the Jikei University School of Medicine [No. 35–398(12035)] approved the study protocol. The study was performed in accordance with the Declaration of Helsinki. Informed Consent Informed consent for this study was obtained in writing from the study participants. Registry and the registration of the study/trial N/A Animal studies N/A References Leal Ghezzi, T. & Campos Corleta, O. 30 Years of Robotic Surgery. World J Surg 40 , 2550-2557, doi:10.1007/s00268-016-3543-9 (2016). Falagario, U. et al. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 17 , 579-590, doi:10.1080/17434440.2020.1762487 (2020). Lee, Z., Kaplan, J., Giusto, L. & Eun, D. Prevention of iatrogenic ureteral injuries during robotic gynecologic surgery: a review. Am J Obstet Gynecol 214 , 566-571, doi:10.1016/j.ajog.2015.10.150 (2016). Hanaoka, M., Kinugasa, Y., Sakai, Y. & Tokunaga, M. World's first report of sigmoidectomy for sigmoid cancer using the Saroa surgical system with tactile feedback. Updates Surg 75 , 2395-2401, doi:10.1007/s13304-023-01659-5 (2023). Lantz, A. et al. Functional and Oncological Outcomes After Open Versus Robot-assisted Laparoscopic Radical Prostatectomy for Localised Prostate Cancer: 8-Year Follow-up. Eur Urol 80 , 650-660, doi:10.1016/j.eururo.2021.07.025 (2021). Hinata, N. et al. Hinotori Surgical Robot System, a novel robot-assisted surgical platform: Preclinical and clinical evaluation. Int J Urol 29 , 1213-1220, doi:10.1111/iju.14973 (2022). Kohjimoto, Y. et al. hinotori(TM) vs. da Vinci(®): propensity score-matched analysis of surgical outcomes of robot-assisted radical prostatectomy. J Robot Surg 18 , 130, doi:10.1007/s11701-024-01877-y (2024). Bravi, C. A. et al. Robot-assisted Radical Prostatectomy with the Novel Hugo Robotic System: Initial Experience and Optimal Surgical Set-up at a Tertiary Referral Robotic Center. Eur Urol 82 , 233-237, doi:10.1016/j.eururo.2022.04.029 (2022). Hussein, A. A. et al. Transition from da Vinci to Versius robotic surgical system: initial experience and outcomes of over 100 consecutive procedures. J Robot Surg 17 , 419-426, doi:10.1007/s11701-022-01422-9 (2023). Ueda, Y. et al. Impact of a pneumatic surgical robot with haptic feedback function on surgical manipulation. Sci Rep 13 , 22615, doi:10.1038/s41598-023-49876-7 (2023). Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Saroa.Tables.xlsx Cite Share Download PDF Status: Published Journal Publication published 30 Dec, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 04 Oct, 2024 Reviews received at journal 02 Oct, 2024 Reviews received at journal 19 Sep, 2024 Reviewers agreed at journal 16 Sep, 2024 Reviewers agreed at journal 12 Sep, 2024 Reviewers invited by journal 08 May, 2024 Editor assigned by journal 06 May, 2024 Editor invited by journal 02 May, 2024 Submission checks completed at journal 02 May, 2024 First submitted to journal 29 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4344298","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":299595893,"identity":"7daa0cb0-9c5b-48ae-a92e-3cbe4fbb9e89","order_by":0,"name":"Kosuke Iwatani","email":"data:image/png;base64,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","orcid":"","institution":"The Jikei University School of Medicine, Kashiwa Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kosuke","middleName":"","lastName":"Iwatani","suffix":""},{"id":299595894,"identity":"b432e1e1-b0a4-46e4-866c-220e0b5e37ca","order_by":1,"name":"Fumihiko Urabe","email":"","orcid":"","institution":"The Jikei University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Fumihiko","middleName":"","lastName":"Urabe","suffix":""},{"id":299595895,"identity":"e6134e92-82c6-4b56-b1a4-97c6d7c7abdf","order_by":2,"name":"Shun Saito","email":"","orcid":"","institution":"The Jikei University School of Medicine, Kashiwa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shun","middleName":"","lastName":"Saito","suffix":""},{"id":299595896,"identity":"f355e9c5-b1f1-4a43-aa83-c8f732353c56","order_by":3,"name":"Shota Kawano","email":"","orcid":"","institution":"The Jikei University School of Medicine, Kashiwa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shota","middleName":"","lastName":"Kawano","suffix":""},{"id":299595897,"identity":"a5f46844-0729-413a-bd3c-d4bfbd708852","order_by":4,"name":"Tomoya Yamasaki","email":"","orcid":"","institution":"Abiko Toho Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomoya","middleName":"","lastName":"Yamasaki","suffix":""},{"id":299595898,"identity":"f36b70f7-0d70-4c10-a91a-2d74e5ebfc85","order_by":5,"name":"Shoji Kimura","email":"","orcid":"","institution":"The Jikei University School of Medicine, Kashiwa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shoji","middleName":"","lastName":"Kimura","suffix":""},{"id":299595899,"identity":"46c0386b-f1c6-4ad8-890c-747bbce07f86","order_by":6,"name":"Hideo Otsuki","email":"","orcid":"","institution":"Abiko Toho Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hideo","middleName":"","lastName":"Otsuki","suffix":""},{"id":299595901,"identity":"e296c24a-d844-4c77-91df-75d87d1f878d","order_by":7,"name":"Kei Fujio","email":"","orcid":"","institution":"Abiko Toho Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kei","middleName":"","lastName":"Fujio","suffix":""},{"id":299595903,"identity":"3aab8314-65f1-4a60-b707-85bef5ff32b8","order_by":8,"name":"Takahiro Kimura","email":"","orcid":"","institution":"The Jikei University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Takahiro","middleName":"","lastName":"Kimura","suffix":""},{"id":299595906,"identity":"9c0f75fe-b235-43a3-8dbc-15f157188a23","order_by":9,"name":"Jun Miki","email":"","orcid":"","institution":"The Jikei University School of Medicine, Kashiwa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Miki","suffix":""}],"badges":[],"createdAt":"2024-04-29 16:54:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4344298/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4344298/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-82531-3","type":"published","date":"2024-12-30T15:56:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56199510,"identity":"86c0cd6a-2daa-43a8-a221-c4b1e92a5de0","added_by":"auto","created_at":"2024-05-09 18:45:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":368128,"visible":true,"origin":"","legend":"\u003cp\u003eSaroa Surgical System.\u003c/p\u003e\n\u003cp\u003e(a) Patient Cart. (b) Surgeon console with 3D–4K monitor. (c) Instrument (length: 33.2 cm). (d) Console sub monitor (displays gripping force and roll clutch control).\u003c/p\u003e","description":"","filename":"Saroa.Figurespptx1.png","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/0bf2620a0e50fc97634553a8.png"},{"id":56198630,"identity":"1de2b6d9-567a-499e-9078-fc0eb3f545ad","added_by":"auto","created_at":"2024-05-09 18:37:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80663,"visible":true,"origin":"","legend":"\u003cp\u003ePort arrangement\u003c/p\u003e\n\u003cp\u003eThe camera port is positioned below the umbilicus, with the left and right ports positioned 8 cm apart.\u003c/p\u003e","description":"","filename":"Saroa.Figurespptx2.png","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/cf33f9843b4940b8c2306891.png"},{"id":56199776,"identity":"bfbd6080-d74d-469b-9d09-9d052d5dec86","added_by":"auto","created_at":"2024-05-09 18:54:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":441474,"visible":true,"origin":"","legend":"\u003cp\u003eOperation setup\u003c/p\u003e\n\u003cp\u003eThe assistant positioned on the right side of the patient. The Saroa Surgical System requires an external electrosurgical generator (located between the console and Saroa).\u003c/p\u003e","description":"","filename":"Saroa.Figurespptx3.png","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/5a9d06de8d205ee62edc60be.png"},{"id":56198273,"identity":"fb12015c-45eb-4e82-897b-2b00da10a17f","added_by":"auto","created_at":"2024-05-09 18:29:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":40828,"visible":true,"origin":"","legend":"\u003cp\u003eTactile feedback\u003c/p\u003e\n\u003cp\u003e(a) Tactile feedback is enabled. (b) Tactile feedback is disabled.\u003c/p\u003e\n\u003cp\u003eTactile feedback allows for object manipulation with reduced gripping force.\u003c/p\u003e","description":"","filename":"Saroa.Figurespptx4.png","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/d06d5b3901d1334cc2efa037.png"},{"id":56199754,"identity":"f4d45d4b-4b70-4060-bf3a-44842098964e","added_by":"auto","created_at":"2024-05-09 18:54:38","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":515497,"visible":true,"origin":"","legend":"\u003cp\u003eTactile feedback in bladder-prostate area\u003c/p\u003e\n\u003cp\u003eThe graph demonstrates the grasping force required to maintain consistent forceps opening while moving from the bladder to the prostate (1→4).\u003c/p\u003e","description":"","filename":"Saroa.Figurespptx5.png","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/145ae8a350d0c622be22f0ef.png"},{"id":56199763,"identity":"fcfc75a7-4e00-4744-81b3-b4a22b20f4c4","added_by":"auto","created_at":"2024-05-09 18:54:43","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1427620,"visible":true,"origin":"","legend":"\u003cp\u003eRoll clutch system\u003c/p\u003e\n\u003cp\u003eSurgeon wrist rotation with clutch activation allows 290 degrees of rotation in each direction (580 degrees total), exceeding the range of motion offered by other robotic systems.\u003c/p\u003e","description":"","filename":"Saroa.Figurespptx6.png","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/4c6a887941f4d2d5bf8fa5e0.png"},{"id":73093145,"identity":"12f4a507-2853-48df-8d50-a6425309bb8f","added_by":"auto","created_at":"2025-01-06 16:07:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3221510,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/0a0fb935-018e-4156-9363-8fe968099b7e.pdf"},{"id":56198272,"identity":"17bcfec5-d3d9-4cde-94f6-d4e861cf28ff","added_by":"auto","created_at":"2024-05-09 18:29:52","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12061,"visible":true,"origin":"","legend":"","description":"","filename":"Saroa.Tables.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4344298/v1/7aae4c5a12c94f5c5f750a3f.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Initial experience with “Saroa” in radical prostatectomy: A novel surgical assist robot featuring tactile feedback and a roll clutch system","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRobotic surgical systems have revolutionized laparoscopic surgery, offering enhanced articulation, dexterity, and precision for complex procedures, such as radical prostatectomy.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e These systems enable surgeons to operate more intuitively, with reduced endoscope tremors and enhanced accuracy.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e However, the risk of injury and hemorrhage associated with excessive force during tissue and organ retraction remains a concern.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Therefore, a novel robotic system known as Saroa (Riverfield Inc., Tokyo, Japan) has been developed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Saroa has a compact design with three pneumatically powered arms that directly transmit the tactile sensation of forceps pressure to the surgeon; moreover, it incorporates a unique roll clutch system for effortless wrist control. Although it has demonstrated utility in colorectal cancer resection,\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e our study is the first to evaluate its effectiveness and safety in robotic-assisted laparoscopic radical prostatectomy (RARP). We compared the perioperative outcomes of RARP between Saroa and the da Vinci (Intuitive Surgical, Sunnyvale, CA, USA) surgical systems.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe enrolled 55 patients who underwent RARP using Saroa (n\u0026thinsp;=\u0026thinsp;7) or da Vinci Xi (n\u0026thinsp;=\u0026thinsp;48) at Jikei University Kashiwa Hospital between January 2022 and January 2024. Procedures were performed by KI and JM (experience with \u0026gt;\u0026thinsp;50 da Vinci Xi cases). The da Vinci Xi system was used between January 2022 and July 2023, and Saroa was used between August 2023 and January 2024. We excluded 24 cases that involved lymphadenectomy or lacked perioperative data. A single pathologist assessed all prostate specimens. Postoperative continence was defined as requiring 0\u0026ndash;1 security pads per day. The Institutional Review Board of the Jikei University School of Medicine [No. 35\u0026ndash;398(12035)] approved the study protocol. RARP using Saroa was performed after obtaining approval from the Highly Difficult Technology Committee and the Medical Safety Committee at our hospital, and informed consent was obtained from all participants.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Procedure\u003c/h2\u003e \u003cp\u003eRARP was performed in a 25\u0026deg; head-down supine position (da Vinci system) or the lithotomy position (Saroa Surgical System). The shorter forceps in the Saroa system necessitated the placement of the camera port below the umbilicus, with lateral ports arranged in a diamond configuration (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We used ERBE VIO 300 D (ERBE USA, Marietta, GA) and Valleylab\u0026trade; FT10 (Medtronic, Minneapolis, MN, USA) electrosurgical generators (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). We used a trans-peritoneal approach with bladder neck preservation. Nerve-sparing decisions followed thorough patient consultation. Vesicourethral anastomosis was performed using continuous 3\u0026ndash;0 Stratafix (Covidien, Mansfield, MA, USA) sutures.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003ePatient background and perioperative outcomes were compared using the Mann-Whitney U and chi-square tests. Statistical analyses were performed using R software (version 4.20, R Foundation for Statistical Computing, Vienna, Austria). P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Outcomes\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;1 presents the baseline characteristics of the study participants. No significant differences were observed between the groups in preoperative demographics, such as patient age, body mass index, baseline serum levels of PSA, and prostate volume. Table\u0026nbsp;2 summarizes the perioperative outcomes. Nerve-sparing procedures were performed in 12 patients (50%) in the da Vinci group. The Saroa group demonstrated significantly longer operative and console times (median operative time: 273 [257\u0026ndash;294] min vs. 218 [189\u0026ndash;230] min, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; median console time: 195 [191\u0026ndash;231] min vs. 136 [121\u0026ndash;162] min, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant differences were found in other surgical outcomes, including estimated blood loss, intraoperative blood transfusion, intraoperative complications, or major postoperative complications (defined by the Clavien-Dindo classification). Surgical positive margin rates and other pathological outcomes were similar between the groups. Urinary continence at 3 months postoperatively did not differ significantly (71.4% vs. 87.5%, p\u0026thinsp;=\u0026thinsp;0.665).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSurgical feasibility\u003c/h2\u003e \u003cp\u003eThe Saroa system integrates novel features, including tactile feedback and a roll clutch system. We measured the grasping force exerted by the robot on organs with and without tactile feedback. Tactile feedback significantly reduced the overall force, indicating that surgeons may apply excessive force without this sensory input (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In addition, force measurements with equal forceps closure revealed significant differences between the bladder and prostate (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), emphasizing the inherent difficulty of visually differentiating tissue boundaries. The roll clutch system proved essential for suturing, enabling deep stitches without re-holding the needle. The clutching mechanism minimized force on the puncture site during needle repositioning (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eRobotics-assisted surgery offers several advantages, including tremor reduction, enhanced precision, shorter learning curves, and improved surgical and oncological outcomes.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Robotic surgery has significantly impacted radical prostatectomy, combining the advantages of open and laparoscopic techniques while enabling precise manipulation at the pelvic floor. We evaluated the effectiveness and safety of Saroa, a novel surgical assistant with tactile feedback, in RARP.\u003c/p\u003e \u003cp\u003eRecent advancements in surgical robots prioritize replicating the dexterity of surgeon hand movements during minimally invasive procedures.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e However, tissue damage caused by excessive force during organ manipulation remains a critical concern. The Saroa system addresses this challenge by incorporating tactile feedback, allowing surgeons to perceive resistance while grasping. This is particularly beneficial for surgeons with limited laparoscopic experience, allowing gentler tissue handling.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Although a firm grasp may be necessary for certain instruments, such as needles, this can lead to finger fatigue. Notably, the grasping force required differs significantly between prostate and bladder tissues (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e); this emphasizes a key advantage over the da Vinci system, which primarily relies on visual cues for bladder neck dissection. Using Saroa, the bladder neck can be recognized using visual and tactile feedback. This dual-sensory approach could broaden its utility in various surgeries. Furthermore, the ability to determine the exact dissection plane through tactile grasping may help surgeons perform higher-quality surgeries.\u003c/p\u003e \u003cp\u003eSaroa incorporates several innovative features designed to enhance precision and workflow in minimally invasive surgery. One key feature is a roll clutch system that facilitates highly precise needle movements, particularly during deep, delicate insertions. Unlike conventional robotic platforms with limited arm rotation, Saroa permits continuous needle driving, minimizing tissue damage. This enhanced control improves needle handling and allows surgeons to perform a wider range of surgical maneuvers. Furthermore, its open console design promotes better communication between the operating surgeon and the surgical team, enabling multiple surgeons to visualize the procedure simultaneously in 3D.\u003c/p\u003e \u003cp\u003eIn our study, the operation took longer using Saroa. This might be attributable to the unfamiliarity of surgeons with the system vs. da Vinci Xi and the absence of a fourth robotic arm. The fourth arm plays a crucial role in procedures such as RARP, which provides necessary tension on pelvic floor organs. This function must be performed by an assistant surgeon when using Saroa, increasing operation time due to reduced coordination in early robotic surgeries; however, surgeon\u0026ndash;assistant coordination is improving with practice. Moreover, plans are underway to introduce two more arms. However, the current three-arm design offers advantages in weight and size, simplifying installation in operating rooms of varying dimensions. Furthermore, its compatibility with standard endoscopes, trocars, and equipment significantly reduces operating costs compared to conventional systems.\u003c/p\u003e \u003cp\u003eOur study is the first to evaluate the effectiveness and safety of Saroa in RARP. Although surgeons experienced in robotic surgery performed the procedures safely, operative times were slightly extended. Further investigation is warranted to assess long-term oncological and functional outcomes following RARP with Saroa.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRARP: Robot-assisted radical prostatectomy\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank RIVERFIELD Inc. for equipment coordination and development, the doctors at Abiko Toho Hospital (KF, HO, TO) for their cooperation, and the Jikei University Kashiwa Hospital staff for their study assistance. In addition, we thank Textcheck Inc. for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted using the Saroa surgical system, which was provided by RIVERFIELD Inc. under a time-limited loan agreement for clinical usage purposes. RIVERFIELD Inc. did not provide any funding or other benefits related to this research.\u003c/p\u003e\n\u003cp\u003eThe authors have no any other relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK.I. designed the study and wrote the initial draft of the manuscript. All other authors contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval of the research protocol by an institutional reviewer board\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the Institutional Review Board of the Jikei University School of Medicine [No. 35\u0026ndash;398(12035)] approved the study protocol. The study was performed in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent for this study was obtained in writing from the study participants.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eRegistry and the registration of the study/trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnimal studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLeal Ghezzi, T. \u0026amp; Campos Corleta, O. 30 Years of Robotic Surgery. \u003cem\u003eWorld J Surg\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 2550-2557, doi:10.1007/s00268-016-3543-9 (2016).\u003c/li\u003e\n\u003cli\u003eFalagario, U.\u003cem\u003e et al.\u003c/em\u003e Robotic-assisted surgery for the treatment of urologic cancers: recent advances. \u003cem\u003eExpert Rev Med Devices\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 579-590, doi:10.1080/17434440.2020.1762487 (2020).\u003c/li\u003e\n\u003cli\u003eLee, Z., Kaplan, J., Giusto, L. \u0026amp; Eun, D. Prevention of iatrogenic ureteral injuries during robotic gynecologic surgery: a review. \u003cem\u003eAm J Obstet Gynecol\u003c/em\u003e \u003cstrong\u003e214\u003c/strong\u003e, 566-571, doi:10.1016/j.ajog.2015.10.150 (2016).\u003c/li\u003e\n\u003cli\u003eHanaoka, M., Kinugasa, Y., Sakai, Y. \u0026amp; Tokunaga, M. World\u0026apos;s first report of sigmoidectomy for sigmoid cancer using the Saroa surgical system with tactile feedback. \u003cem\u003eUpdates Surg\u003c/em\u003e \u003cstrong\u003e75\u003c/strong\u003e, 2395-2401, doi:10.1007/s13304-023-01659-5 (2023).\u003c/li\u003e\n\u003cli\u003eLantz, A.\u003cem\u003e et al.\u003c/em\u003e Functional and Oncological Outcomes After Open Versus Robot-assisted Laparoscopic Radical Prostatectomy for Localised Prostate Cancer: 8-Year Follow-up. \u003cem\u003eEur Urol\u003c/em\u003e \u003cstrong\u003e80\u003c/strong\u003e, 650-660, doi:10.1016/j.eururo.2021.07.025 (2021).\u003c/li\u003e\n\u003cli\u003eHinata, N.\u003cem\u003e et al.\u003c/em\u003e Hinotori Surgical Robot System, a novel robot-assisted surgical platform: Preclinical and clinical evaluation. \u003cem\u003eInt J Urol\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 1213-1220, doi:10.1111/iju.14973 (2022).\u003c/li\u003e\n\u003cli\u003eKohjimoto, Y.\u003cem\u003e et al.\u003c/em\u003e hinotori(TM) vs. da Vinci(\u0026reg;): propensity score-matched analysis of surgical outcomes of robot-assisted radical prostatectomy. \u003cem\u003eJ Robot Surg\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 130, doi:10.1007/s11701-024-01877-y (2024).\u003c/li\u003e\n\u003cli\u003eBravi, C. A.\u003cem\u003e et al.\u003c/em\u003e Robot-assisted Radical Prostatectomy with the Novel Hugo Robotic System: Initial Experience and Optimal Surgical Set-up at a Tertiary Referral Robotic Center. \u003cem\u003eEur Urol\u003c/em\u003e \u003cstrong\u003e82\u003c/strong\u003e, 233-237, doi:10.1016/j.eururo.2022.04.029 (2022).\u003c/li\u003e\n\u003cli\u003eHussein, A. A.\u003cem\u003e et al.\u003c/em\u003e Transition from da Vinci to Versius robotic surgical system: initial experience and outcomes of over 100 consecutive procedures. \u003cem\u003eJ Robot Surg\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 419-426, doi:10.1007/s11701-022-01422-9 (2023).\u003c/li\u003e\n\u003cli\u003eUeda, Y.\u003cem\u003e et al.\u003c/em\u003e Impact of a pneumatic surgical robot with haptic feedback function on surgical manipulation. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 22615, doi:10.1038/s41598-023-49876-7 (2023).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Robot-assisted radical prostatectomy, sense of tactile, Japanese surgical robot","lastPublishedDoi":"10.21203/rs.3.rs-4344298/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4344298/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eRobotic surgical systems have revolutionized laparoscopic surgery, offering enhanced articulation, dexterity, and precision for complex procedures, such as radical prostatectomy. Although these systems enable surgeons to operate more intuitively, the risk of injury and hemorrhage from excessive force during tissue retraction remains a concern.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe enrolled 31 patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) using either the Saroa or da Vinci Xi surgical system at our hospital between January 2022 and January 2024. Perioperative complications and pathological outcomes were compared using the Mann-Whitney U and chi-square tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNo significant differences in preoperative demographics were observed between the systems. Operation times were longer using Saroa, but significant differences were not observed between the systems in terms of pathological outcomes, urinary continence, and postoperative complications.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis is the first study to evaluate the effectiveness and safety of the Saroa surgical system for RARP. This system incorporates several innovative features, such as a roll clutch system and tactile feedback, which enhance precision and workflow in minimally invasive surgery. The tactile feedback may benefit surgeons with limited laparoscopic experience, promoting gentler tissue handling. Further investigation is warranted to assess long-term oncological and functional outcomes following RARP with Saroa.\u003c/p\u003e","manuscriptTitle":"Initial experience with “Saroa” in radical prostatectomy: A novel surgical assist robot featuring tactile feedback and a roll clutch system","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-09 18:29:40","doi":"10.21203/rs.3.rs-4344298/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-04T04:39:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-02T20:24:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-19T10:26:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63668293381480717275210691583122674381","date":"2024-09-16T07:52:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173767587487119605818885042605979916670","date":"2024-09-12T11:56:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-08T13:01:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-06T15:41:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-02T16:33:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-02T16:28:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-04-29T16:03:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14963e53-5275-4117-8788-702b1bd93183","owner":[],"postedDate":"May 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T15:59:07+00:00","versionOfRecord":{"articleIdentity":"rs-4344298","link":"https://doi.org/10.1038/s41598-024-82531-3","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-12-30 15:56:52","publishedOnDateReadable":"December 30th, 2024"},"versionCreatedAt":"2024-05-09 18:29:40","video":"","vorDoi":"10.1038/s41598-024-82531-3","vorDoiUrl":"https://doi.org/10.1038/s41598-024-82531-3","workflowStages":[]},"version":"v1","identity":"rs-4344298","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4344298","identity":"rs-4344298","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}