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Totally robotic right hemicolectomy: a multicentre case-matched technical and peri-operative comparison of port placements and da Vinci models

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Abstract

The objective of the study was to review the technical and peri-operative outcomes using the da Vinci Xi (dVXi) and da Vinci Si (dVSi) models with suprapubic port placement (SPPP) or traditional port placements (TPP) during a robotic right hemicolectomy (RRHC). A retrospective review was undertaken of prospectively maintained databases of RRHC performed by two senior colorectal surgeons in the USA and Australia. Data were prospectively collected for patient demographics, intra-operative technical outcomes and peri-operative clinical outcomes. A cohort of 138 patients underwent RRHC between 2013 and 2017: 134 (97%) had intra-corporeal anastomoses (ICA), 50% for polyp disease and 38% for cancer. 16 (12%) patients had post-operative complications, 11 (8%) of whom had only one complication. There were five (4%) anaemias requiring transfusion; five (4%) anastomotic bleeds; one (1%) leucocytosis/sepsis; two (1%) paralytic ileus; and two (1%) delayed readmissions. There were no conversions to open operations, anastomotic leaks, 30-day readmissions, or 30-day mortalities. With dVSi compared to dVXi, median (IQR) total operation time (TOT) reduced by 16% [134 (118–169) min versus 113 (90–132), p < 0.001]. dVXi had shorter console times (CST) [75 (62–97) min vs 94 (77–108), p = 0.004]. SPPP seemed more advantageous than TPP with less CST [75 (60–98) min versus 85 (70–106), p = 0.02]; less TOT [110 (90–130) min versus 130 (108–167), p < 0.001]; and shorter LOS [2 (2–3) days versus 3(2–3), p = 0.03]. There are operative technical improvements and peri-operative patient clinical benefits during RRHC with ICA using either da Vinci models or port placement configurations. It appears more advantageous to use dVXi with SPPP configuration as our preferred setup for RHHC. Many gastrointestinal surgeons foresee potential benefits of robotic surgery (RS) over conventional laparoscopic surgery, hence evaluation of RS in both routine and more complex operations is needed (Kwak and Kim in J Robot Surg 5:65–72, 2011).

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Funding

No financial support was received for this research.

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Authors and Affiliations

  1. Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD, Australia

    Auerilius E. R. Hamilton, Mark D. Chatfield & Andrew R. L. Stevenson

  2. Holy Spirit Northside Private Hospital, Brisbane, QLD, Australia

    Auerilius E. R. Hamilton & Andrew R. L. Stevenson

  3. Colorectal Surgery Unit, Department of Colorectal Surgery, The Royal Brisbane and Women’s Hospital, Herston, Brisbane, QLD, 4029, Australia

    Auerilius E. R. Hamilton & Andrew R. L. Stevenson

  4. Oklahoma Science Health Centre, Oklahoma Surgical Hospital, Tulsa, OK, USA

    Craig S. Johnson

Authors
  1. Auerilius E. R. Hamilton
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  2. Mark D. Chatfield
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  3. Craig S. Johnson
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  4. Andrew R. L. Stevenson
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Correspondence to Auerilius E. R. Hamilton.

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Conflict of interest

AERH and MDC declare that they have no conflict of interest. CSJ and ARLS are proctors and lecturers for Intuitive Surgical and have received speaker honoraria in the past but industry funding for this research. AERH, MDC, CSJ and ARLS have not received grants or scholarships for this research. Three of the authors were involved in the operative clinical treatment of patients utilising the da Vinci RSP. All authors are in agreement with the content written therein. This manuscript was a summary of the collective cohort of two experienced senior surgeons (CSJ and ARLS).

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Hamilton, A.E.R., Chatfield, M.D., Johnson, C.S. et al. Totally robotic right hemicolectomy: a multicentre case-matched technical and peri-operative comparison of port placements and da Vinci models. J Robotic Surg 14, 479–491 (2020). https://doi.org/10.1007/s11701-019-01014-0

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  • DOI: https://doi.org/10.1007/s11701-019-01014-0

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