Evaluating the Sina flex Robotic Telesurgery System for Fallopian Tube-like Procedures: A Canine Uterine Horn Model Feasibility Study

Evaluating the Sina flex Robotic Telesurgery System for Fallopian Tube-like Procedures: A Canine Uterine Horn Model Feasibility Study | 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 Research Article Evaluating the Sina flex Robotic Telesurgery System for Fallopian Tube-like Procedures: A Canine Uterine Horn Model Feasibility Study Vahid Shahbazi, Mir Sepehr Pedram, Alireza Mirbagheri, Dorsa Saneei, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8155359/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract This study evaluated the performance of Sina flex Robotic Telesurgery System, Iran's first multipurpose robotic surgical platform, in simulated tubal ligation procedures using prepubertal canine uterine horns (1–2 mm diameter) as anatomical analogs for human fallopian tubes. Six female stray dogs underwent robotic-assisted bilateral uterine horn ligation. The procedures were completed with a mean operative time of 81.7 ± 47.2 with minimal blood loss not requiring intervention in any cases. Postoperative monitoring confirmed successful outcomes in all cases without any intraoperative complications, with all animals achieving full recovery within 24 hours. These outcomes demonstrate Sina flex Robotic Telesurgery System's precision in delicate surgical applications and mark significant progress in developing this indigenous robotic platform for clinical use. Robotic Surgery Minimally Invasive Surgery Tubal Ligation Simulation Telesurgery Figures Figure 1 Introduction Successful surgical innovations prioritize enhanced patient safety and quality of life. Minimally invasive surgery (MIS) represents the most transformative advancement in this domain over the past three decades, utilizing high-definition cameras and micro-tools to perform procedures through small incisions. While MIS reduces operative trauma and recovery time, it faces limitations in precision-dependent procedures due to impaired depth perception (2D visualization) and restricted instrument maneuverability. Robotic surgical systems address these challenges by restoring 3D visualization and enhancing dexterity through multi-Degree-of-Freedom (DOF) instruments [2, 22]. The Sina flex Robotic Telesurgery System (Sina Robotics and medical Innovators Co., Ltd., Tehran, Iran- 2021), is Iran's flagship surgical robot (Fig. 1 ), embodies these advancements with 6 + 1 DoF articulated arms, tremor filtration (< 0.5 mm error), real-time stereoscopic imaging and 5 mm single use instruments [22]. Its design specifically targets microsurgical applications where sub-millimeter accuracy is critical—such as tubal ligation, a common sterilization procedure carrying inherent risks of bleeding (0.5-2%), organ injury (1%), and infection (2%) in conventional laparoscopy [16, 17]. This study pioneers the evaluation of Sina flex Robotic Telesurgery System for tubal occlusion using prepubertal canine uterine horns (1–2 mm diameter) as validated anatomical analogs for human fallopian tubes [15]. We hypothesize Sina's technical capabilities will reduce anastomosis failure rates vs. manual laparoscopy; Decrease intraoperative morbidity; Shorten surgeon adaptation time thereby establishing its viability for gynecologic microsurgeries. Materials and Methods Animal Samples: Six female stray dogs aged 8–12 months (prepubertal) and weighing 18–22 kg were quarantined for two weeks at the Faculty of Veterinary Medicine, University of Tehran. Clinical examinations, complete blood count (CBC), and abdominal ultrasound confirmed health status and non-pregnancy. All procedures were approved by the University of Tehran Animal Ethics Committee (Code: 28885.6.42). On surgery day, animals were transferred to the experimental surgical suite at Imam Khomeini Hospital. Anesthesia: Anesthesia induction was achieved through intravenous injection of Ketamine (5 mg/kg) and Diazepam (0.2 mg/kg). Cefazolin was administered as a prophylactic antibiotic (22 mg/kg), and Tramadol was used for analgesia (3 mg/kg), along with saline solution at a rate of 10 ml/kg/hr. After intubation, the animal was connected to the BLEASE Frontline 560 anesthesia machine (BLEASE Medical Equipment Ltd., UK), and anesthesia was maintained with Isoflurane. Vital signs, including SpO₂, heart rate, and respiratory rate, were monitored by a veterinary anesthesiologist. The animal was positioned in a dorsal recumbent position on the surgical table, and the abdominal area was scrubbed in preparation for surgery. Surgical Procedure Using the Sina flex Robotic Telesurgery System : Following abdominal insufflation with CO₂ to 15 mmHg via a Veress needle, three laparoscopic ports were placed: one 10-mm port for the camera at the umbilical scar, and two 5-mm ports for instruments, each positioned 15 cm from the camera port (Fig. 1 .A). After connecting the instruments and camera to the robotic arms, the veterinary surgeon—who had completed 100 hours of simulator training—performed the procedure from the console. The console provides displays and hand controls for precise manipulation, along with protective systems to prevent sudden movements and tissue damage. After identifying the target tissue, the surgeon used graspers and monopolar cautery to ligate and transect the right uterine horn (Fig. 1 .B). Instruments were withdrawn under camera guidance, CO₂ was evacuated, and port sites were closed in two layers by the assistant surgeon. The animal was disconnected from anesthesia, transferred to recovery, and upon regaining consciousness, returned to the holding facility at the Faculty of Veterinary Medicine, University of Tehran Post-Surgical Monitoring: The animals were monitored for 10 days post-operatively. Specific assessments included daily evaluation of incision sites for signs of infection (redness, discharge) or dehiscence, measurement of body temperature and assessment of appetite and behavior. Analgesia was maintained with Tramadol (2 mg/kg, BID) for the first 3 days. Results The surgical procedure for uterine horn ligation was successfully performed on all six animals. The mean total operative time across all six cases was 81.7 ± 47.2 minutes. A pronounced reduction in procedure time was observed, decreasing from the first three cases (107.3 ± 49.2 minutes) to the last three cases (49.3 ± 4.0 minutes), which indicates a rapid learning curve associated with the system. Blood loss was negligible in all procedures, requiring no intervention. No intraoperative complications or injuries to adjacent organs occurred, and no postoperative infections were observed. All animals regained full consciousness within 24 hours and returned to normal activity within seven days while receiving antibiotics and analgesics (Table 1 ). Table 1 Operative and postoperative outcomes of robotic-assisted uterine horn ligation in six canines using the Sina flex Robotic Telesurgery system. Case Duration of Surgery (min) Estimated Blood Loss (mL) Intraoperative Complications Postoperative Complications Recovery Status 1 95 < 5 Lack of robot lens control, coding errors, electrocautery error None Full recovery 2 65 50 Sleeve interference with animal holder None Full recovery 3 162 75 Malfunction of suction None Full recovery 4 39 < 5 None None Full recovery 5 42 < 5 None None Full recovery 6 47 50 None None Full recovery Discussion and Conclusion Robotic surgical systems have emerged as pivotal tools for enhancing precision in minimally invasive procedures [2]. While platforms like the Da Vinci (Intuitive Surgical, USA) and REVO-I have demonstrated efficacy in complex procedures such as tubal anastomosis and partial nephrectomy in both human and animal models [19, 21], their high cost remains a significant barrier to widespread adoption, particularly in developing economies [4, 14]. The present study is the first to evaluate the feasibility and performance of the indigenous Sina flex Robotic Telesurgery System for uterine horn ligation in a canine model, thereby addressing the critical need for cost-effective and accessible surgical robotics. Our findings are consistent with prior literature documenting the core advantages of robotic assistance. The successful completion of all six procedures without conversion to open surgery or major intraoperative complications aligns with the high technical success rates reported for the Da Vinci system in human fallopian tube surgery [19] and the REVO-I system in a porcine model [18, 21]. The fundamental technical benefits observed in our study—including tremor filtration, stereoscopic three-dimensional visualization, and enhanced instrument stability—which were crucial for operating on delicate 1–2 mm structures, directly corroborate the advantages previously reported for the Zeus system during microsurgical tubal anastomosis [20]. A distinct feature of the Sina flex Robotic Telesurgery System in our evaluation was its modular design and ergonomic console, which contributed to a notably short learning curve for the veterinary surgeon. This observation supports the ergonomic claims made by the system's developers [22] and represents a significant practical advantage for clinical deployment and training. The safety profile of the Sina flex Robotic Telesurgery System, evidenced by negligible blood loss and the absence of postoperative complications in our cohort, underscores its capability for safe handling of delicate tissues. However, certain technical limitations were observed. The restricted range of motion of the robotic arms and the performance of the hemostasis system were identified as areas for improvement. These constraints resonate with challenges reported in early generations of other robotic platforms, such as the limited instrument articulation noted in the REVO-I system [21]. Furthermore, the unstable internet connectivity in our operational environment prevented a reliable assessment of the system's telesurgical capabilities, highlighting a critical infrastructural prerequisite for realizing the full potential of remote surgery. In conclusion, this feasibility study establishes the Sina flex Robotic Telesurgery System as a viable and promising robotic platform for gynecologic and veterinary microsurgical procedures. Its successful application in a canine uterine horn model, a recognized anatomical analog for human fallopian tubes [15], demonstrates its potential for clinical translation. Future work should focus on technical refinements to address the identified limitations, validation of the system's performance in more complex surgical scenarios leveraging its modularity, and formal assessment of its efficacy in a dedicated telesurgical environment. Declarations Author Contribution Dr. Mir Sepehr Pedram and Dr. Alireza Mirbagheri designed and supervised the study.Dr. Vahid Shahbazi and Dr. Ali Reza Shahmir performed the experiments, data collection, and data analysis.Dr. Dorsa Saneei prepared the initial draft of the manuscript.All authors critically reviewed, revised, and approved the final version of the manuscript. References Diana M and Marescaux J. Robotic surgery. Journal of British Surgery 2015; 102: e15-e28. Lanfranco AR, Castellanos AE, Desai JP, et al. Robotic surgery: a current perspective. Annals of surgery 2004; 239: 14-21. Mahvash M and Zenati M. Toward a hybrid snake robot for single-port surgery. In: 2011 annual international conference of the IEEE engineering in medicine and biology society 2011, pp.5372-5375. IEEE. Breitenstein S, Nocito A, Puhan M, et al. Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study. Annals of surgery 2008; 247: 987-993. Markar S, Karthikesalingam A, Hagen M, et al. Robotic vs. laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease: systematic review and meta-analysis. The International Journal of Medical Robotics and Computer Assisted Surgery 2010; 6: 125-131. Giulianotti PC, Coratti A, Sbrana F, et al. Robotic liver surgery: results for 70 resections. Surgery 2011; 149: 29-39. Huffmanm L, Pandalai P, Boulton B, et al. Robotic Heller myotomy: a safe operation with higher postoperative quality-of-life indices. Surgery 2007; 142: 613-620. Kim M-C, Heo G-U and Jung G-J. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surgical endoscopy 2010; 24: 610-615. Ayloo S, Buchs NC, Addeo P, et al. Robot-assisted sleeve gastrectomy for super-morbidly obese patients. Journal of Laparoendoscopic & Advanced Surgical Techniques 2011; 21: 295-299. Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surgical endoscopy 2010; 24: 1646-1657. Leroy J, Diana M, Barry B, et al. Perirectal Oncologic Gateway to Retroperitoneal Endoscopic Single-Site Surgery (PROGRESSS) A Feasibility Study for a New NOTES Approach in a Swine Model. Surgical innovation 2012; 19: 345-352. Delaney CP, Lynch AC, Senagore AJ, et al. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Diseases of the colon & rectum 2003; 46: 1633-1639. Morton J, Hardwick RH, Tilney HS, et al. Preclinical evaluation of the versius surgical system, a new robot-assisted surgical device for use in minimal access general and colorectal procedures. Surgical endoscopy 2021; 35: 2169-2177. Maeso S, Reza M, Mayol JA, et al. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Annals of surgery 2010; 252: 254-262. Monnet E. Small animal soft tissue surgery . John Wiley & Sons, 2023. Obstetricians ACo and Gynecologists. Permanent Contraception: Ethical Issues and Considerations: ACOG Committee Statement No. 8. Obstet Gynecol 2024; 143: e31-e39. Patil E and Jensen JT. Permanent contraception for women. In: Seminars in Reproductive Medicine 2016, pp.139-144. Thieme Medical Publishers. Abdel Raheem A, Troya IS, Kim DK, et al. Robot-assisted Fallopian tube transection and anastomosis using the new REVO-I robotic surgical system: feasibility in a chronic porcine model. BJU international 2016; 118: 604-609. Degueldre M, Vandromme J, Huong PT, et al. Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study. Fertility and sterility 2000; 74: 1020-1023. Margossian H, Garcia-Ruiz A, Falcone T, et al. Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study. Journal of Laparoendoscopic & Advanced Surgical Techniques 1998; 8: 69-73. Kim DK, Park DW and Rha KH. Robot-assisted partial nephrectomy with the REVO-I robot platform in porcine models. European urology 2016; 69: 541-542. Mirbagheri A, Farahmand F, Sarkar S, et al. The sina robotic telesurgery system. Handbook of robotic and image-guided surgery . Elsevier, 2020, pp.107-121. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 06 Dec, 2025 Reviewers agreed at journal 05 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers invited by journal 04 Dec, 2025 Editor assigned by journal 25 Nov, 2025 Submission checks completed at journal 25 Nov, 2025 First submitted to journal 19 Nov, 2025 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. We do this by developing innovative software and high quality services for the global research community. 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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-8155359","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556568149,"identity":"c78de9a0-2ae2-4593-a112-bb2cc7ff3f4c","order_by":0,"name":"Vahid Shahbazi","email":"","orcid":"","institution":"University of Tehran","correspondingAuthor":false,"prefix":"","firstName":"Vahid","middleName":"","lastName":"Shahbazi","suffix":""},{"id":556568150,"identity":"60cbd57a-2544-4d9b-ae59-a2c2ad16a3fa","order_by":1,"name":"Mir Sepehr 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15:35:48","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":38601,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8155359/v1/27fa9fedff78739c174c383c.html"},{"id":97745532,"identity":"00d6186a-68c0-4cab-8209-f2b1bb8ca5c4","added_by":"auto","created_at":"2025-12-09 00:25:06","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53766,"visible":true,"origin":"","legend":"\u003cp\u003eA. Sina\u003csub\u003eflex\u003c/sub\u003e robotic system, B. Ligation procedure of the target organ using surgeon console\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8155359/v1/12d475b951ab2ecb20a698b1.jpeg"},{"id":97902708,"identity":"22baeaec-237b-484c-a14f-fe8c6f51be07","added_by":"auto","created_at":"2025-12-10 15:53:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":547080,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8155359/v1/84335205-65f6-46c9-9426-3cdf359c36d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluating the Sina \u003csub\u003eflex\u003c/sub\u003e Robotic Telesurgery System for Fallopian Tube-like Procedures: A Canine Uterine Horn Model Feasibility Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuccessful surgical innovations prioritize enhanced patient safety and quality of life. Minimally invasive surgery (MIS) represents the most transformative advancement in this domain over the past three decades, utilizing high-definition cameras and micro-tools to perform procedures through small incisions. While MIS reduces operative trauma and recovery time, it faces limitations in precision-dependent procedures due to impaired depth perception (2D visualization) and restricted instrument maneuverability. Robotic surgical systems address these challenges by restoring 3D visualization and enhancing dexterity through multi-Degree-of-Freedom (DOF) instruments [2, 22].\u003c/p\u003e\u003cp\u003eThe Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System (Sina Robotics and medical Innovators Co., Ltd., Tehran, Iran- 2021), is Iran's flagship surgical robot (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), embodies these advancements with 6\u0026thinsp;+\u0026thinsp;1 DoF articulated arms, tremor filtration (\u0026lt;\u0026thinsp;0.5 mm error), real-time stereoscopic imaging and 5 mm single use instruments [22]. Its design specifically targets microsurgical applications where sub-millimeter accuracy is critical\u0026mdash;such as tubal ligation, a common sterilization procedure carrying inherent risks of bleeding (0.5-2%), organ injury (1%), and infection (2%) in conventional laparoscopy [16, 17].\u003c/p\u003e\u003cp\u003eThis study pioneers the evaluation of Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System for tubal occlusion using prepubertal canine uterine horns (1\u0026ndash;2 mm diameter) as validated anatomical analogs for human fallopian tubes [15]. We hypothesize Sina's technical capabilities will reduce anastomosis failure rates vs. manual laparoscopy; Decrease intraoperative morbidity; Shorten surgeon adaptation time\u003c/p\u003e\u003cp\u003ethereby establishing its viability for gynecologic microsurgeries.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eAnimal Samples:\u003c/h2\u003e\u003cp\u003eSix female stray dogs aged 8\u0026ndash;12 months (prepubertal) and weighing 18\u0026ndash;22 kg were quarantined for two weeks at the Faculty of Veterinary Medicine, University of Tehran. Clinical examinations, complete blood count (CBC), and abdominal ultrasound confirmed health status and non-pregnancy. All procedures were approved by the University of Tehran Animal Ethics Committee (Code: 28885.6.42). On surgery day, animals were transferred to the experimental surgical suite at Imam Khomeini Hospital.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAnesthesia:\u003c/h3\u003e\n\u003cp\u003eAnesthesia induction was achieved through intravenous injection of Ketamine (5 mg/kg) and Diazepam (0.2 mg/kg). Cefazolin was administered as a prophylactic antibiotic (22 mg/kg), and Tramadol was used for analgesia (3 mg/kg), along with saline solution at a rate of 10 ml/kg/hr. After intubation, the animal was connected to the BLEASE Frontline 560 anesthesia machine (BLEASE Medical Equipment Ltd., UK), and anesthesia was maintained with Isoflurane. Vital signs, including SpO₂, heart rate, and respiratory rate, were monitored by a veterinary anesthesiologist. The animal was positioned in a dorsal recumbent position on the surgical table, and the abdominal area was scrubbed in preparation for surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical Procedure Using the Sina\u003c/b\u003e\u003csub\u003e\u003cb\u003eflex\u003c/b\u003e\u003c/sub\u003e \u003cb\u003eRobotic Telesurgery System\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eFollowing abdominal insufflation with CO₂ to 15 mmHg via a Veress needle, three laparoscopic ports were placed: one 10-mm port for the camera at the umbilical scar, and two 5-mm ports for instruments, each positioned 15 cm from the camera port (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.A). After connecting the instruments and camera to the robotic arms, the veterinary surgeon\u0026mdash;who had completed 100 hours of simulator training\u0026mdash;performed the procedure from the console. The console provides displays and hand controls for precise manipulation, along with protective systems to prevent sudden movements and tissue damage.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAfter identifying the target tissue, the surgeon used graspers and monopolar cautery to ligate and transect the right uterine horn (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.B). Instruments were withdrawn under camera guidance, CO₂ was evacuated, and port sites were closed in two layers by the assistant surgeon. The animal was disconnected from anesthesia, transferred to recovery, and upon regaining consciousness, returned to the holding facility at the Faculty of Veterinary Medicine, University of Tehran\u003c/p\u003e\n\u003ch3\u003ePost-Surgical Monitoring:\u003c/h3\u003e\n\u003cp\u003eThe animals were monitored for 10 days post-operatively. Specific assessments included daily evaluation of incision sites for signs of infection (redness, discharge) or dehiscence, measurement of body temperature and assessment of appetite and behavior. Analgesia was maintained with Tramadol (2 mg/kg, BID) for the first 3 days.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe surgical procedure for uterine horn ligation was successfully performed on all six animals. The mean total operative time across all six cases was 81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;47.2 minutes. A pronounced reduction in procedure time was observed, decreasing from the first three cases (107.3\u0026thinsp;\u0026plusmn;\u0026thinsp;49.2 minutes) to the last three cases (49.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 minutes), which indicates a rapid learning curve associated with the system. Blood loss was negligible in all procedures, requiring no intervention. No intraoperative complications or injuries to adjacent organs occurred, and no postoperative infections were observed. All animals regained full consciousness within 24 hours and returned to normal activity within seven days while receiving antibiotics and analgesics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eOperative and postoperative outcomes of robotic-assisted uterine horn ligation in six canines using the Sina\u003c/b\u003e\u003csub\u003e\u003cb\u003eflex\u003c/b\u003e\u003c/sub\u003e \u003cb\u003eRobotic Telesurgery system.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDuration of\u003c/p\u003e\u003cp\u003eSurgery (min)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEstimated Blood\u003c/p\u003e\u003cp\u003eLoss (mL)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntraoperative Complications\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePostoperative Complications\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRecovery Status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLack of robot lens control, coding errors,\u003c/p\u003e\u003cp\u003eelectrocautery error\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFull recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSleeve interference\u003c/p\u003e\u003cp\u003ewith animal holder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFull recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMalfunction of suction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFull recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFull recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFull recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFull recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eRobotic surgical systems have emerged as pivotal tools for enhancing precision in minimally invasive procedures [2]. While platforms like the Da Vinci (Intuitive Surgical, USA) and REVO-I have demonstrated efficacy in complex procedures such as tubal anastomosis and partial nephrectomy in both human and animal models [19, 21], their high cost remains a significant barrier to widespread adoption, particularly in developing economies [4, 14]. The present study is the first to evaluate the feasibility and performance of the indigenous Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System for uterine horn ligation in a canine model, thereby addressing the critical need for cost-effective and accessible surgical robotics.\u003c/p\u003e\u003cp\u003eOur findings are consistent with prior literature documenting the core advantages of robotic assistance. The successful completion of all six procedures without conversion to open surgery or major intraoperative complications aligns with the high technical success rates reported for the Da Vinci system in human fallopian tube surgery [19] and the REVO-I system in a porcine model [18, 21]. The fundamental technical benefits observed in our study\u0026mdash;including tremor filtration, stereoscopic three-dimensional visualization, and enhanced instrument stability\u0026mdash;which were crucial for operating on delicate 1\u0026ndash;2 mm structures, directly corroborate the advantages previously reported for the Zeus system during microsurgical tubal anastomosis [20]. A distinct feature of the Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System in our evaluation was its modular design and ergonomic console, which contributed to a notably short learning curve for the veterinary surgeon. This observation supports the ergonomic claims made by the system's developers [22] and represents a significant practical advantage for clinical deployment and training.\u003c/p\u003e\u003cp\u003eThe safety profile of the Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System, evidenced by negligible blood loss and the absence of postoperative complications in our cohort, underscores its capability for safe handling of delicate tissues. However, certain technical limitations were observed. The restricted range of motion of the robotic arms and the performance of the hemostasis system were identified as areas for improvement. These constraints resonate with challenges reported in early generations of other robotic platforms, such as the limited instrument articulation noted in the REVO-I system [21]. Furthermore, the unstable internet connectivity in our operational environment prevented a reliable assessment of the system's telesurgical capabilities, highlighting a critical infrastructural prerequisite for realizing the full potential of remote surgery.\u003c/p\u003e\u003cp\u003eIn conclusion, this feasibility study establishes the Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System as a viable and promising robotic platform for gynecologic and veterinary microsurgical procedures. Its successful application in a canine uterine horn model, a recognized anatomical analog for human fallopian tubes [15], demonstrates its potential for clinical translation. Future work should focus on technical refinements to address the identified limitations, validation of the system's performance in more complex surgical scenarios leveraging its modularity, and formal assessment of its efficacy in a dedicated telesurgical environment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr. Mir Sepehr Pedram and Dr. Alireza Mirbagheri designed and supervised the study.Dr. Vahid Shahbazi and Dr. Ali Reza Shahmir performed the experiments, data collection, and data analysis.Dr. Dorsa Saneei prepared the initial draft of the manuscript.All authors critically reviewed, revised, and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDiana M and Marescaux J. Robotic surgery. \u003cem\u003eJournal of British Surgery\u003c/em\u003e 2015; 102: e15-e28.\u003c/li\u003e\n\u003cli\u003eLanfranco AR, Castellanos AE, Desai JP, et al. 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Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study. \u003cem\u003eJournal of Laparoendoscopic \u0026amp; Advanced Surgical Techniques\u003c/em\u003e 1998; 8: 69-73.\u003c/li\u003e\n\u003cli\u003eKim DK, Park DW and Rha KH. Robot-assisted partial nephrectomy with the REVO-I robot platform in porcine models. \u003cem\u003eEuropean urology\u003c/em\u003e 2016; 69: 541-542.\u003c/li\u003e\n\u003cli\u003eMirbagheri A, Farahmand F, Sarkar S, et al. The sina robotic telesurgery system. \u003cem\u003eHandbook of robotic and image-guided surgery\u003c/em\u003e. Elsevier, 2020, pp.107-121.\u003c/li\u003e\n\u003c/ol\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":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Robotic Surgery, Minimally Invasive Surgery, Tubal Ligation Simulation, Telesurgery","lastPublishedDoi":"10.21203/rs.3.rs-8155359/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8155359/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study evaluated the performance of Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System, Iran's first multipurpose robotic surgical platform, in simulated tubal ligation procedures using prepubertal canine uterine horns (1\u0026ndash;2 mm diameter) as anatomical analogs for human fallopian tubes. Six female stray dogs underwent robotic-assisted bilateral uterine horn ligation. The procedures were completed with a mean operative time of 81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;47.2 with minimal blood loss not requiring intervention in any cases. Postoperative monitoring confirmed successful outcomes in all cases without any intraoperative complications, with all animals achieving full recovery within 24 hours. These outcomes demonstrate Sina\u003csub\u003e\u003cem\u003eflex\u003c/em\u003e\u003c/sub\u003e Robotic Telesurgery System's precision in delicate surgical applications and mark significant progress in developing this indigenous robotic platform for clinical use.\u003c/p\u003e","manuscriptTitle":"Evaluating the Sina flex Robotic Telesurgery System for Fallopian Tube-like Procedures: A Canine Uterine Horn Model Feasibility Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-09 00:25:01","doi":"10.21203/rs.3.rs-8155359/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-11T22:53:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T22:41:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56948025396188614458517039328860663868","date":"2025-12-06T13:37:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228534995267247978015233258197231232434","date":"2025-12-05T10:09:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33127028388688346086397490568485674717","date":"2025-12-05T01:41:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-05T01:09:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-25T16:58:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-25T12:04:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2025-11-19T12:30:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3bbf3b41-aacb-4445-9381-b3a9fc4f044f","owner":[],"postedDate":"December 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-13T17:23:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-09 00:25:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8155359","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8155359","identity":"rs-8155359","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}