Use of the new Integrated Table Motion for the Da Vinci Xi surgical system in abdominal surgical procedures

PURPOSE Integrated Table Motion (ITM) for the da Vinci Xi Surgical System is a new feature comprising of a Trumpf TS7000dV Operating Table, that communicates wirelessly with the da Vinci Xi. The feature allows the surgical staff to reposition the patient without undocking the robot from the patient and without removing instruments from inside the abdomen. ITM has been specifically developed to improve multiquadrant robotic surgery. We herein present the first human use of this device across multiple surgical disciplines in the EU. METHODS Between May and October 2015 one of the first human use of ITM was conducted in a post market study in the EU in which 30 cases across different specialties were prospectively enrolled. We included general surgery procedures, urological procedures and gynecological procedures. Variables examined included patient characteristics and intraoperative data. Primary end-points were: ITM efficacy, safety and efficiency. For these reasons we evaluated the number of table moves per case, duration of each table move, table positions attained , reasons for moving the table and the states of instruments and endoscope during table move (inserted or removed). We also evaluated the safety of ITM by recording occurrence of adverse events related to the use of ITM. RESULTS Twelve patients underwent general surgery procedures (six cases of anterior rectal resection (ARR) with TME, 3 cases of right hemicolectomy, a case of subtotal gastrectomy, a case of hepatic resection and a case of ventral hernia repair. Gynecological procedures included five cases of hysterectomy, a case of repair of rectal prolapse and a case of uterine prolapse. Urological procedures included seven cases of prostatectomy, a case of nephrectomy, two cases of partial nephrectomy and a case of pyeloplasty. The mean ITM moves during the colorectal procedures was 3, while ITM was moved two times for repair of rectal prolapsed, three times during subtotal gastrectomy and only one time during liver resection and ventral hernia repair, resulting in 35 instances of table moves in 13 procedures. The mean ITM moves during the repair of uterine prolapse was 5, while ITM was moved on average 3.4 times during hysterectomy, resulting in 22 instances of table moves in 6 procedures. The mean ITM moves during prostatectomy was 3.1, while ITM was moved 2 times during partial and total nephrectomy and pyeloplasty, resulting in 30 instances of table moves in 11 procedures. Majority of moves (>70%) took less than 2 minutes to complete. The primary reason for using ITM was to gain internal exposure in 82 moves (93%). The endoscope was left inserted during 91-93% of table movements, while the instruments were left inserted in 95-97% of moves. No external collisions or other problems related to the operating table were noted. There were no ITM related surgical complications or need for conversion to laparoscopy or laparotomy. There were no ITM safety-related observations and no adverse events ITM or device-related. CONCLUSIONS This preliminary study demonstrated the efficiency of ITM for the da Vinci Xi Surgical System, which enabled patient repositioning without disrupting surgical workflow by allowing the surgeon to leave instruments and the scope docked to the patient. ITM has been shown to be safe, and no adverse events related to its use were reported. Further studies can be useful to demonstrate if ITM could enable procedures or part of procedures to be done robotically that would otherwise be difficult, and if ITM could improve operative efficiency by reducing surgical operative time.