A case control study comparing the new robotic EndoWrist linear staplers for Da Vinci Xi with traditional laparoscopic staplers in anterior rectal resections

Background/Hypothesis: The new robotic linear staplers for the Da Vinci Xi, inserted through a specific 12-mm robotic trocars, are controlled directly by the surgeon at the console and equipped with EndoWrist technology. This study aims to compare the operative results of the first group of patients undergoing lower anterior resection for cancer with the new Da Vinci Xi system and the new staplers, versus a comparable group in which they were used articulated traditional laparoscopic staplers. Materials and Methods: From December 2015 to May 2016, twelve patients underwent anterior resection of the rectum with the aid of robotic EndoWrist stapler 45 mm (group Xi-RobSTAP) at our center. The results have been compared, by a case-control methodology, with a similar pool of patients who have performed the same type of intervention with the use of a 60 mm traditional laparoscopic endostapler (Xi-TradSTAP group). Results: No need to convert to laparoscopy or laparotomy in both groups. There were not significant differences in the two groups in mean operative time and mean docking time (326 min versus 279 min RobSTAP Xi-Xi-TradSTAP group, p = 0:08). In Xi-RobSTAP group we used a mean of 2.1 charges instead a mean of 3.2 in Xi-TradSTAP group with a significant difference (p = 0.001). The rates of intra-operative complications and the average hospital stay were similar (6.8 days in Xi-RobSTAP group versus 6.7 days in the Xi-TradSTAP group; p = 0.8). Conclusions: In our preliminary experience the new robotic linear staplers have proved to be easy to use and able to facilitate the step of transection of the rectum. The lower average number of charges used for the distal section could result in a lower incidence of anastomotic leaks, but these preliminary results, although encouraging, need confirmation in further studies.