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Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si

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Abstract

Background

Robotic rectal resection with da Vinci Si has some technical limitations, which could be overcome by the new da Vinci Xi. We compare short-term surgical and functional outcomes following robotic rectal resection with total mesorectal excision for cancer, with the da Vinci Xi (Xi-RobTME group) and the da Vinci Si (Si-RobTME group).

Methods

The first consecutive 30 Xi-RobTME were compared with a Si-RobTME control group of 30 patients, selected using a one-to-one case-matched methodology from our prospectively collected Institutional database, comprising all cases performed between April 2010 and September 2016 by a single surgeon. Perioperative outcomes were compared. The impact of minimally invasive TME on autonomic function and quality of life was analyzed with specific questionnaires.

Results

The docking and overall operative time were shorter in the Xi-RobTME group (p < 0.001 and p < 0.05 respectively). The mean differences of overall operative time and docking time were −33.8 min (95% CI −5.1 to −64.5) and −6 min (95% CI −4.1 to −7.9), respectively. A fully-robotic approach with complete splenic flexure mobilization was used in 30/30 (100%) of the Xi-RobTME cases and in 7/30 (23%) of the Si-RobTME group (p < 0.001). The hybrid approach in males and patients with BMI > 25 kg/m2 was necessary in ten patients (45 vs. 0%, p < 0.001) and in six patients (37 vs. 0%, p < 0.05), in the Si-RobTME and Xi-RobTME groups, respectively. There were no differences in conversion rate, mean hospital stay, pathological data, and in functional outcomes between the two groups before and at 1 year after surgery.

Conclusion

The technical advantages offered by the da Vinci Xi seem to be mainly associated with a shorter docking and operative time and with superior ability to perform a fully-robotic approach. Clinical and functional outcomes seem not to be improved, with the introduction of the new Xi platform.

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Funding

The authors declare that no funding support was received for this study.

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Authors and Affiliations

  1. General Surgery Unit, University of Pisa, Pisa, Italy

    Luca Morelli, Gregorio Di Franco, Simone Guadagni, Leonardo Rossi, Matteo Palmeri, Niccolò Furbetta, Desirée Gianardi, Matteo Bianchini, Giovanni Caprili & Cristiano D’Isidoro

  2. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy

    Luca Morelli, Franco Mosca & Andrea Moglia

  3. Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK

    Alfred Cuschieri

  4. General Surgery Unit, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Luca Morelli

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  1. Luca Morelli
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  2. Gregorio Di Franco
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Correspondence to Luca Morelli.

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Disclosures

Luca Morelli, Gregorio Di Franco, Simone Guadagni, Leonardo Rossi, Matteo Palmeri, Niccolò Furbetta, Desirèe Gianardi, Mattero Bianchini, Giovanni Caprili, Cristiano D’Isidoro, Franco Mosca, Andra Moglia, and Alfred Cuschieri have no conflicts of interest or financial ties to disclose.

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Morelli, L., Di Franco, G., Guadagni, S. et al. Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc 32, 589–600 (2018). https://doi.org/10.1007/s00464-017-5708-5

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