Evaluating force feedback in robotic nephrectomy: clinical outcomes and recovery of bowel function

Introduction A long-recognised limitation of robotic surgery is the lack of haptic feedback during tissue handling. The new da Vinci 5 (dV5) surgical system introduced force feedback (FFB) technology to address this. Preclinical studies show that FFB reduces applied forces during tissue handling; however, clinical outcomes data remain limited. We hypothesised that FFB can reduce colonic trauma and expedite recovery of bowel function (ROBF). Methods This prospective cohort study included 59 patients who underwent transperitoneal partial or radical nephrectomy between November 2023 and June 2025, performed by three high-volume robotic surgeons. Patients were divided into dV5 (FFB) or Xi (non-FFB) cohorts. ROBF was defined as the passage of flatus or bowel movement. Intraoperative force, postoperative ileus (POI) and operative time were also analysed. Statistical analysis included Mann-Whitney U and Pearson’s χ 2 tests. Results The dV5 cohort (n=34) achieved ROBF within 1 day in 62% of patients, compared with 28% in the Xi cohort (n=25, p=0.02). Median intraoperative force during colonic mobilisation in the dV5 cohort was 1.6 Newtons (N) (range: 1.1–2.6 n). No POI cases occurred in the dV5 cohort, while one (4%) was reported in the Xi group. Median length of stay was 1 day in both cohorts (p=0.89). Conclusions FFB technology in robotic kidney surgery is associated with faster ROBF, potentially due to reduced colonic trauma as shown in this pilot study. These findings support further research into FFB’s broader applications and impact on outcomes in urologic procedures.