Integrated Table Motion for Da Vinci Xi: Intersphincteric Rectal Resection for Cancer Combined With Enucleation of Distal Pancreatic Tumor

Introduction:The Integrated Table Motion (ITM) is the new operating table developed by Intuitive, that works together via Bluetooth with the Da Vinci Xi surgical cart, so that it allows patient’ re-position without undocking the robot and with instruments inside the abdomen. We present a case of intersphincteric resection and enucleation of neuroendocrine tumor of the tail of the pancreas using Da Vinci Xi and the specific operating table. Materials and methods: A 77-years old man with a very low lying rectal cancer and a neuroendocrine tumor of the tail of the pancreas was referred to our center. He was operated on with Da Vinci Xi® platform with left lower quadrant trocars disposition. The perineal phase was easy performed because of the previous trans-abdominal intersphinctericdissection and consists in hand sewn colo-anal-anastomosis. Results: The procedure was successfully completed in 380 min. The patient position changed two times during the intervention with instruments left inside the abdomen and without undocking the robot. Firstly the patient was arranged in 15° Trendelenburg and 25° tilted to the right for inferior mesenteric vein, for the splenic flexure and descending colon mobilization and for enucleation of the neuroendocrine tumor of the tail of the pancreas. Then for Total Mesorectal Excision we use a 20° Trendelenburg and reduced to 15° the tilted position to the right. No external collision or other problems related to the operating bed was noted. There were no surgical complications or a need for conversion to laparoscopy or laparotomy. The patient have an uneventful recovery andhe was discharged from hospital after 9 days. Conclusions:The Da Vinci Xi®with ITM is safe and feasible andseems to give some advantages in multi-quadrant combined surgery. These new versatile devices offer potential advantages by reducing the operative time, increasing the ability to perform surgeries with totally robotic technique and making the operations more fluid, even in cases in which involve more procedures.