Performance of da Vinci Stapler during robotic-assisted right colectomy with intracorporeal anastomosis
Applications for surgical staplers continue to grow, due to the increase in minimally invasive surgical approaches, and range from vessel ligation to tissue transection and anastomoses. Complications associated with stapled tissue, such as bleeding or leaks, continue to be a concern for surgeons, as both can be associated with prolonged operative times and can contribute to postoperative morbidity and mortality. The goal of this retrospective study was to evaluate the performance of the da Vinci® Xi EndoWrist® Stapler 45 with SmartClamp™ technology during robotic-assisted right colectomy with intracorporeal anastomosis. We reviewed 113 consecutive cases from four medical centers. Preclinical diagnoses were inflammatory bowel disease (IBD) (n = 5), benign bowel disease (n = 77), and malignant bowel disease (n = 31). No anastomotic leaks occurred; one event of anastomotic bleeding (0.88%) resolved without surgical intervention. Overall, there were 643 clamp attempts (5.7 attempts per case), and 570 fires (5.0 fires per case). SmartClamp™ occurrences happened in approximately one out of three cases, with the highest proportion of occurrences in the IBD group (2.0 occurrences per case). The most commonly fired reload was blue (1.5 mm closed height) with 4.1 blue reloads fired per case overall. No incomplete fires occurred during the procedures. The study data demonstrate the performance of the da Vinci Xi EndoWrist® Stapler 45 as used in right colon resection with intracorporeal anastomosis. The collection and analysis of these data provide surgeons with information related to stapler firings, which were not previously available; as such, this analysis may lead to deductions that are useful for intraoperative decision-making and clinical outcomes.
KeywordsColectomy Intracorporeal anastomosis Colorectal disease Bowel disease Stapler Robotic assisted
The authors appreciate clinical research funding from Intuitive Surgical, Inc. (Sunnyvale, CA USA) for study data collection and for the editorial support. The authors had full control over the interpretation of the data analysis and over the manuscript drafts and revisions, and all authors approved the final manuscript submission.
Compliance with ethical standards
Conflict of interest
Dr. Johnson receives consulting and education fees from Intuitive Surgical; Dr. Marx receives fees from Intuitive for education and case observation research; and Dr. Soliman is a consultant and lecturer for Intuitive and is on the medical advisory board for C-SATS. Dr. Kassir reports no conflicts of interest or disclosures.
All procedures, which were carried out and described in this study, were in accordance with the ethical standards of each institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Due to the retrospective nature of this study, formal consent was not required.
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