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Transitioning from Da Vinci Si to Xi: assessing surgical outcomes at a high-volume robotic center

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Abstract

Purpose

In the emerging field of robotics, only few studies investigated the transition between different robotic platforms in terms of surgical outcomes. We aimed at assessing surgical outcomes of patients receiving robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN) at a high-volume robotic center during the transition from Si to Xi Da Vinci surgical systems.

Methods

We analyzed data of 1884 patients undergoing RARP (n = 1437, 76%) and RAPN (n = 447, 24%) at OLV hospital (Aalst, Belgium) between 2011 and 2021. For both procedures, we assessed operative time, estimated blood loss, length of stay, and positive surgical margins. For RARP, we investigated length of catheterization and PSA persistence after surgery, whereas warm ischemia time, clampless surgery, and acute kidney injury (AKI) were assessed for RAPN. Multivariable analyses (MVA) investigated the association between robotic platform (Si vs. Xi) and surgical outcomes after adjustment for patient- and tumor-related factors.

Results

A total of 975 (68%) and 462 (32%) patients underwent RARP performed with the Si vs. Xi surgical system, respectively. Baseline characteristics did not differ between the groups. On MVA, we did not find evidence of a difference between the groups with respect to operative time (estimate: 1.07) or estimated blood loss (estimate: 32.39; both p > 0.05). Median (interquartile range [IQR]) length of stay was 6 (3, 6) and 4 (3, 5) days in the Si vs. Xi group, respectively (p < 0.0001). On MVA, men treated with the Xi vs. Si robot had lower odds of PSM (Odds ratio [OR]: 0.58; p = 0.014). A total of 184 (41%) and 263 (59%) patients received RAPN with the Si and Xi robotic system, respectively. Baseline characteristics, including demographics, functional data, and tumor-related features did not differ between the groups. On MVA, operative time was longer in the Xi vs. Si group (estimate: 30.54; p = 0.006). Patients treated with the Xi vs. Si system had higher probability of undergoing a clampless procedure (OR: 2.56; p = 0.001), whereas the risk of AKI did not differ between the groups (OR: 1.25; p = 0.4). On MVA, patients operated with the Xi robot had shorter length of stay as compared to the Si group (estimate: − 0.86; p = 0.003), whereas we did not find evidence of an association between robotic system and PSM (OR: 1.55; p = 0.3).

Conclusion

We found that the Xi robot allowed for improvements in peri-operative outcomes as compared to the Si platform, with lower rate of positive margins for RARP and higher rate of off-clamp procedures for RAPN. Hospital stay was also shorter for patients operated with the Xi vs. Si robot, especially after robot-assisted partial nephrectomy. Awaiting future investigations—in particular, cost analyses—these results have important implications for patients, surgeons, and healthcare policymakers.

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References

  1. Lane T (2018) A short history of robotic surgery. Ann R Coll Surg Engl 100(6 supp):5–7. https://doi.org/10.1308/rcsann.supp1.5

    Article  PubMed  PubMed Central  Google Scholar 

  2. George EI, Brand TC, LaPorta A, Marescaux J, Satava RM (2018) Origins of robotic surgery: from skepticism to standard of care. JSLS. https://doi.org/10.4293/JSLS.2018.00039

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yates DR, Vaessen C, Roupret M (2011) From Leonardo to Da Vinci: the history of robot-assisted surgery in urology. BJU Int 108(11):1708–1713. https://doi.org/10.1111/j.1464-410X.2011.10576.x

    Article  PubMed  Google Scholar 

  4. Lei KY, Xie WJ, Fu SQ, Ma M, Sun T (2021) A comparison of the Da Vinci Xi vs. Da Vinci Si surgical systems for radical prostatectomy. BMC Surg. https://doi.org/10.1186/s12893-021-01406-w

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ferguson JM et al (2020) Comparing the accuracy of the Da Vinci Xi and Da Vinci Si for image guidance and automation. Int J Med Robot Comput Assist Surg 16(6):1–10. https://doi.org/10.1002/rcs.2149

    Article  Google Scholar 

  6. Azhar RA, Elkoushy MA, Aldousari S (2019) Robot-assisted urological surgery in the Middle East: where are we and how far can we go? Arab J Urol 17(2):106–113. https://doi.org/10.1080/2090598X.2019.1601003

    Article  PubMed  PubMed Central  Google Scholar 

  7. Intuive Surgical Inc, “Sustainability report 2021,” 2022

  8. Abdel Raheem A et al (2017) Da Vinci Xi and Si platforms have equivalent perioperative outcomes during robot-assisted partial nephrectomy: preliminary experience. J Robot Surg 11(1):53–61. https://doi.org/10.1007/s11701-016-0612-x

    Article  PubMed  Google Scholar 

  9. Feng Z, Feng MP, Feng DP, Solórzano CC (2020) Robotic-assisted adrenalectomy using Da Vinci Xi vs. Si: are there differences? J Robot Surg 14(2):349–355. https://doi.org/10.1007/s11701-019-00995-2

    Article  PubMed  Google Scholar 

  10. Martini A et al (2020) Contemporary techniques of prostate dissection for robot-assisted prostatectomy. Eur Urol 78(4):583–591. https://doi.org/10.1016/j.eururo.2020.07.017

    Article  PubMed  Google Scholar 

  11. Farinha R et al (2022) Selective suturing or sutureless technique in robot-assisted partial nephrectomy: results from a propensity-score matched analysis. Eur Urol Focus 8(2):506–513. https://doi.org/10.1016/j.euf.2021.03.019

    Article  PubMed  Google Scholar 

  12. Antonio CM et al (2022) Robotic partial nephrectomy for hilar renal masses. Urol Video J 13:100118. https://doi.org/10.1016/j.urolvj.2021.100118

    Article  Google Scholar 

  13. Gandaglia G et al (2017) Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. Eur Urol 72(4):632–640. https://doi.org/10.1016/j.eururo.2017.03.049

    Article  PubMed  Google Scholar 

  14. Chawla LS et al (2017) Acute kidney disease and renal recovery: consensus report of the acute disease quality initiative (ADQI) 16 workgroup. Nat Rev Nephrol 13(4):241–257. https://doi.org/10.1038/nrneph.2017.2

    Article  PubMed  Google Scholar 

  15. Bravi CA et al (2019) The impact of experience on the risk of surgical margins and biochemical recurrence after robot-assisted radical prostatectomy: a learning curve study. J Urol 202(1):108–113. https://doi.org/10.1097/JU.0000000000000147

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bravi CA et al (2022) The surgical learning curve for biochemical recurrence after robot-assisted radical prostatectomy. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2022.06.010

    Article  PubMed  Google Scholar 

  17. Bianchi L et al (2018) A novel approach for apical dissection during robot-assisted radical prostatectomy: the ‘Collar’ technique. Eur Urol Focus 4(5):677–685. https://doi.org/10.1016/j.euf.2018.01.004

    Article  PubMed  Google Scholar 

  18. Farinha R et al (2022) Potential contenders for the leadership in robotic surgery. J Endourol 36(3):317–326. https://doi.org/10.1089/end.2021.0321

    Article  PubMed  Google Scholar 

Download references

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Author notes

  1. Carlo A. Bravi and Angelo Mottaran contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

    Carlo A. Bravi, Angelo Mottaran, Luca Sarchi, Adele Piro, Marco Paciotti, Luigi Nocera, Federico Piramide, Eleonora Balestrazzi, Maria Peraire, Rui Farinha, Gabriele Sorce, Frederiek D’Hondt, Ruben De Groote, Geert De Naeyer & Alexandre Mottrie

  2. ORSI Academy, Ghent, Belgium

    Carlo A. Bravi, Angelo Mottaran, Luca Sarchi, Adele Piro, Marco Paciotti, Luigi Nocera, Federico Piramide, Eleonora Balestrazzi, Maria Peraire, Rui Farinha, Gabriele Sorce, Pieter De Backer, Frederiek D’Hondt, Ruben De Groote, Geert De Naeyer & Alexandre Mottrie

  3. Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Angelo Mottaran & Eleonora Balestrazzi

  4. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    Adele Piro

  5. Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy

    Marco Paciotti

  6. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Luigi Nocera & Gabriele Sorce

  7. Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy

    Federico Piramide

  8. Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples “Federico II”, Naples, Italy

    Claudia Collà-Ruvolo

  9. Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy

    Silvia Rebuffo

Authors
  1. Carlo A. Bravi
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  2. Angelo Mottaran
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  3. Luca Sarchi
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  4. Adele Piro
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  9. Maria Peraire
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  10. Rui Farinha
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Contributions

CAB: protocol/project development, data collection or management, data analysis, manuscript writing/editing; AM: protocol/project development, manuscript writing/editing; LS: data collection or management; AP: data collection or management; MP: data collection or management; LN: data collection or management; FP: data collection or management; EB: data collection or management; MP: data collection or management; RF: data collection or management; GS: data collection or management; CC-R: data collection or management; SR: data collection or management; PDB: data collection or management; FD’H: data collection or management; RDG: data collection or management; GDN: data collection or management; AM: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Carlo A. Bravi.

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The study was approved by the appropriate institutional ethics committee and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Bravi, C.A., Mottaran, A., Sarchi, L. et al. Transitioning from Da Vinci Si to Xi: assessing surgical outcomes at a high-volume robotic center. World J Urol 41, 3737–3744 (2023). https://doi.org/10.1007/s00345-023-04665-9

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  • DOI: https://doi.org/10.1007/s00345-023-04665-9

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