Magnetic-Assisted Robotic and Laparoscopic Renal Surgery: Initial Clinical Experience with the Levita Magnetic Surgical System.

Introduction: The Levita™ Magnetic Surgical System (LMSS) is a new device that can provide retraction using magnets and can reduce the number of ports used during laparoscopic and robotic procedure. It is U.S. Food and Drug Administration (FDA) approved for laparoscopic cholecystectomy, bariatric operation, and robotic radical prostatectomy. Our objective was to evaluate the safety and feasibility of the magnetic surgical system during renal procedure. Methods: We performed a prospective, single-center, single-arm, open-label study to assess the safety and performance of the LMSS. The system includes a deployable, single-use magnetic grasper and a reusable external magnet. Selected patients undergoing either laparoscopic or robotic renal procedure from April 2019 to August 2019 were included. Robotic procedures were performed with the da Vinci Xi or single-port (SP) surgical platforms. Preoperative demographic, intraoperative data, and postoperative data were collected and analyzed. Results: Ten procedures were performed using the LMSS. Cases included Xi robotic partial nephrectomy ( n  = 3), Xi robotic radical nephrectomy ( n  = 2), SP robotic partial nephrectomy ( n  = 2), SP robotic pyeloplasty ( n  = 1), laparoscopic donor nephrectomy ( n  = 1), and laparoscopic radical nephrectomy ( n  = 1). No cases required conversion to an open procedure. Issues included one small liver capsular tear from the device jaws necessitating fulguration and occasional robotic "recoverable fault" errors when the external magnet was placed too close to the robotic arms. All patients were discharged home on postoperative day 1 or 2, and there were no readmissions within 30 days. Conclusions: This is the first report on the use of the LMSS for renal procedure. Its use for laparoscopic and robotic renal procedure appears safe and feasible. The grasper is especially useful for exposing the renal hilum during dissection and the ureteropelvic junction during SP robotic procedures, mimicking multiport techniques. Further study is required to optimize use of the LMSS and evaluate its cost effectiveness.