Da Vinci Xi Full Robotic Colorectal Resections with Other Major Oncological Surgical Procedures: Preliminary Experience

Aims: The new characteristics of da Vinci XiÒ could have an important role in robotic multiquadrant surgery, especially in colorectal surgery and particularly in attaining fully robotic colorectal resection combined with other major surgical procedures. Methods: We reviewed the charts of all patients undergoing fully robotic combination procedures involving colorectal resections using the da Vinci Xi, from January 2015 to October 2015. Variables examined include patient demographic characteristics, preopera- tive data and postoperative variables. Ten patients were included in the study, including 12 colorectal procedures: 5 right hemicolectomy and 5 anterior rectal resections with TME were performed in combination with sigmoidectomy (1), right nephrectomy (2), hys- terectomy (1), hepatic resection (3), enucleation of pancreatic tail lesion (2) and ileocecal resection (1). Results: All the operations were completed by a fully robotic approach, without conversion to hand assisted laparoscopy or laparotomy, and without hybrid approaches or without the need to change the robotic cart position. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for ‘left lower quadrant’. Simultane- ous procedures in the same quadrant or left quadrant and pelvis, or left/right and upper, were performed with a single docking/single targeting approach; in cases of left/right quadrant or right quadrant/pelvis, we performed a dual-dock operation where we re-targeted using the camera to orient the system towards the new work space (an opposite facing quadrant) and redocked the remaining arms. No external collisions or problems related to trocar positions were noted. Mean overall procedural time was 360 min (±128 min). No patient experienced postoperative surgical complications and the mean hospital stay was 6 days (±3 days). Conclusions:The herein presented a high success rate of robotic colorectal resection combined with other surgical interventions for synchronous tumors, without conversion or excessive operating time, suggest the efficacy of the robotic platform, and in particular the new released product da Vinci Xi, in minimally invasive multiquadrant combined surgery. A further possible advantage may be provided by da Vinci Xi Integrated Table Motion feature (available only in the EU), that allows patients to be repositioned without undocking the robot and without removing instruments from inside the abdomen.