First Series of Rectal Resection with the New Robotic Endo-wrist Staplers for da Vinci XI: A Case Match-Study vs Traditional Laparoscopic Staplers

Introduction: The new robotic linear stapler, for the da Vinci Xi, is a device equipped with an Endo-Wrist technology and directly controlled by the surgeon at the console. We compared the operative and short-term results between patients undergoing a robotic anterior rectal resection with total mesorectal excision (TME) for cancer with the new endo-wrist staplers, and those in which were used the traditional laparoscopic ones.. Materials and Methods: We collected data about fifteen patients underwent an anterior rectal resection with TME for cancer, using the robotic Endo-Wrist 45 mm staplers (group Xi-RobSTAP) at our multidisciplinary robotic center from December 2015 to July 2016.The case-control group was composed, using a case-control methodology, by a similar pool of patients who performed the same surgery with the use of a 60 mm traditional laparoscopic endo-stapler, applied by the bed-side assistant (Xi-TradSTAP group). A diverting ileostomy was fashioned in 13 patients of each group. Results:There were no significant differences in the two groups in mean operative time (315±59.2 min RobSTAP Xi group versus 295±60.8 min Xi-TradSTAP group, p=0.3). The mean number of stapler’s charges for each case, was significantly different (2.1±0.2 charges in Xi-RobSTAP group versus 2.9±0.5 in Xi-TradSTAP group; p=0.001). The rates of intra-operative complications and the average hospital stay were similar (7.5±2.7 days in Xi-RobSTAP group versus 6.8±1.3 days in the Xi-TradSTAP group; p= 0.5). No need to convert to laparoscopy or laparotomy in both groups. Anastomotic fistula at contrast enema (not symptomatic except for one case of Xi-TradSTAP group) performed during the follow up period, was higher in the Xi-TradSTAP group, although without statistically significance (3 leak versus 1 leak in the Xi-RobSTAP group; p=0.15).. Although not statistically significant, time elapse between the intervention and stoma closure was shorter in the Xi-RobSTAP group (4.2±3.1 month in Xi-TradSTAP and 2.7±2.1 month in Xi-RobSTAP group; p=0.17). Conclusion: In our preliminary experience the new robotic linear staplers seemed to give some advantages in terms of easy transection that could result in a reduction of average number of stapler firing used during rectal resection and with a lower incidence of anastomotic leakage. These promising data are very preliminary and need to be verified on a larger experiences.