New Technologies in Robotic Rectal Resection: da Vinci Xi, Integrated Table Motion, Endowrist Robotic Stapler and Indocyanine Green Fluorescence

ackground: The use of new technologies in surgery has expanded enormously in recent decades, not only in open or laparoscopic surgery, but in the new frontier of robotic surgery as well. We present a case of anterior rectal resection with the Da Vinci Xi, the new Integrated Table Motion (ITM), the new robotic EndoWrist linear staplers and the indocyanine green fluorescence.Materials and Methods: A 78-years old man with an adenocarcinoma of the rectum who previously underwent neoadiuvant short course radiotherapy, was operated with Da Vinci Xi® platform with left lower quadrant trocar’ disposition.Results: The procedure was successfully completed in 245 min. The patient position was changed twice during the intervention with instruments left inside the abdomen and without undocking the robot. Firstly the patient was arranged for the inferior mesenteric vein, for the splenic flexure and descending colon mobilization and then for Total Mesorectal Excision. 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 section of the rectum was performed with the new robotic linear staplers with EndoWrist technology. We also used fire fly indocyanine green fluorescence to assess anastomotic perfusion. The patient had an uneventful recovery and was discharged from hospital after 8 days. Conclusions: The use of new technologies for the Da Vinci Xi® could give some advantages in colorectal surgery, increasing the ability to perform full robotic surgeries, reducing the operative time by simplifying the workflow and increasing the safety of the procedures