First Experience in Colorectal Surgery with the New Integrated Table Motion for the DA VINCI XI Surgical System

INTRODUCTION Integrated Table Motion (ITM) for the da Vinci Xi Surgical System is a new operating table that communicates wirelessly with the da Vinci and allows the surgical staff to reposition the patient without undocking the robot and without removing instruments from inside the abdomen. ITM has been specifically developed to improve multiquadrant robotic surgery such as colorectal surgery. 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 40 cases across different specialties were prospectively enrolled. The colorectal study group comprised of 10 patients. Primary end-points were: ITM efficacy, safety and efficiency. Variables examined included patient characteristics and intraoperative data. We evaluated the targeting success, number of moves per case, duration of each table motion, table position attained, reasons for moving table and the state of instruments and scope during table motion (inserted or removed). RESULTS Seven patients underwent anterior rectal resection (ARR) with TME, while 3 patients underwent right hemicolectomy. The mean ITM moves during the ARR was 3 while it was 4 for right hemicolectomy resulting in 33 instances of table moves in 10 procedures. The ITM duration per move took less than 2 minutes in 25 of 33 of moves(75,8%). The reason for using ITM was to gain internal exposure forallmoves. The endoscope was left inserted during 31 of the 33 table movements (94%), while the instruments were left inserted in 28 of the 33 moves (84.8%). No external collisions or other problems related to the operating table were noted. The mean robotic operative time was 230.4 min. 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. CONCLUSIONS ITM 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 are needed to confirm if ITM could be useful in multiquadrant 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.