Clinical Trial on Safety and Efficacy of Thoracoabdominal Endoscopic Surgical System for Pediatric Surgery

This is a prospective, multi-center, single-arm, target-value clinical trial designed to evaluate the safety and effectiveness of the Thoracic and Abdominal Endoscopic Surgery System (Model WJ-SR01-200) when used in pediatric surgical procedures. The trial is conducted in accordance with the Declaration of Helsinki, relevant Good Clinical Practice (GCP) requirements, and applicable regulatory guidelines.

The investigational device is a master-slave robotic surgical system that includes a surgeon console, patient surgery platform, endoscopic image processor, 3D electronic endoscope, surgical instruments, and accessories. It is intended to facilitate precise, minimally invasive thoracoscopic and laparoscopic procedures in pediatric patients.

A total of 64 subjects aged 0 to less than 18 years will be enrolled. Eligible subjects must have clinical indications for thoracic or abdominal laparoscopic surgery and be medically suitable for minimally invasive surgery. Key exclusion criteria include previous surgery at the target site that may preclude laparoscopic intervention, uncontrolled systemic infection, severe coagulopathy, severe cardiovascular instability, epilepsy, cognitive impairment, drug addiction, pregnancy, and recent participation in other interventional clinical trials.

During the study, eligible subjects will undergo surgery using the investigational Thoracic and Abdominal Endoscopic Surgery System. The surgical procedures include pyeloplasty, ureteral reimplantation, ovarian tumor resection, radical resection of Hirschsprung disease, fundoplication, segmental lung resection, choledochal cyst resection, and other representative pediatric laparoscopic procedures.

The study consists of a screening period (within 14 days before surgery), an intraoperative assessment, an in-hospital follow-up, and a 30-day post-operative follow-up. Clinical evaluations include vital signs, routine blood tests, liver and kidney function tests, coagulation function, infectious disease serology, imaging examinations as clinically indicated, and age-appropriate pediatric pain assessments including CRIES, FLACC, and FPS-R scales.

The primary efficacy endpoint is the rate of non-conversion from the investigational robotic system to open surgery or conventional laparoscopic surgery. The primary safety endpoint is the incidence of device-related or possibly device-related Clavien-Dindo Grade ≥3 complications from the first incision up to 30 days postoperatively.

Secondary outcome measures include operation time, estimated intraoperative blood loss, transfusion rate, length of hospital stay, post-operative pain scores, device performance, and surgeon intraoperative physical discomfort using a dedicated questionnaire. Additional safety assessments include overall complication rate (Clavien-Dindo Grade ≥1), device deficiency rate, 30-day readmission rate, 30-day reoperation rate, 30-day mortality rate, changes in vital signs, laboratory abnormalities, adverse events (AEs), and serious adverse events (SAEs).

All adverse events and device deficiencies will be monitored, recorded, and reported in compliance with regulatory requirements. Serious adverse events will be reported to the sponsor, ethics committee, and relevant regulatory authorities within the required timeframes.

The trial uses a single-arm target-value design without a control group or blinding. Sample size was calculated based on the primary efficacy and safety endpoints in accordance with the Technical Review Guidelines for Abdominal Endoscopic Surgery Systems (2023 Revision). A target sample size of 64 subjects was determined to account for a dropout rate of approximately 15%.

Statistical analysis will be performed using SAS software (version 9.4 or higher). Efficacy analyses will be conducted using the Full Analysis Set (FAS) and Per-Protocol Set (PPS). Safety analyses will be performed using the Safety Analysis Set (SS). Descriptive statistics will be used for demographic and baseline characteristics. Proportions will be summarized with frequencies and percentages, and continuous variables with mean, standard deviation, median, and range. The 95% confidence intervals will be calculated for primary endpoints to test whether the study meets predefined clinical performance goals.

The trial will be conducted at multiple registered clinical research institutions. The principal investigator at the lead center is responsible for overall study conduct, data quality, and compliance with the protocol. Site personnel will be trained on the protocol, device operation, and GCP prior to study initiation. Regular monitoring will be performed to ensure adherence to the protocol, accurate data collection, and proper management of the investigational device.

Written informed consent will be obtained from the legally authorized representative of each subject before any study-related procedures. Assent will be obtained from subjects who are developmentally capable of participating in the decision. The study protocol has been approved by the independent ethics committee/institutional review board of each participating institution.

• Operation time [Time frame: Intraoperative]
• Estimated intraoperative blood loss (mL) [Time frame: Intraoperative]
• Pediatric pain score [Time frame: Postoperative 24±4 hours or prior to discharge]
• Transfusion rate [Time frame: Intraoperative]
• Length of hospital stay [Time frame: Before discharge]
• Device performance evaluation [Time frame: Postoperative within 24 hours]
• Surgeon intraoperative physical load [Time frame: Postoperative within 24 hours]