Robotic oncologic colorectal surgery with a new robotic platform (CMR Versius): hope or hype? A preliminary experience from a full-robotic case-series

Abstract

Background The present case-series describes the first full-robotic colorectal resections performed with the new CMR Versius platform (Cambridge Medical Robotics Surgical, 1 Evolution Business Park, Cambridge, United Kingdom) by an experienced robotic surgeon. Methods In a period between July 2020 and December 2020, patients aged 18 years or older, who were diagnosed with colorectal cancer and were fit for minimally invasive surgery, underwent robotic colorectal resection with CMR Versius robotic platform at “Casa di Cura Cobellis” in Vallo della Lucania,Salerno, Italy. Three right colectomies, 2 sigmoid colectomies and 1 anterior rectal resection were performed. All the procedures were planned as fully robotic. Surgical data were retrospectively reviewed from a prospectively collected database. Results Four patients were male and 2 patients were female with a median (range) age of 66 (47–72) years. One covering ileostomy was created. Full robotic splenic flexure mobilization was performed. No additional laparoscopic gestures or procedures were performed in this series except for clipping and stapling which were performed by the assistant surgeon due to the absence of robotic dedicated instruments. Two ileocolic anastomoses, planned as robotic-sewn, were performed extracorporeally. One Clavien–Dindo II complication occurred due to a postoperative blood transfusion. Median total operative time was 160 (145–294) min for right colectomies, 246 (191–300) min for sigmoid colectomies and 250 min for the anterior rectal resection. Conclusions The present series confirms the feasibility of full-robotic colorectal resections while highlighting the strengths and the limitations of the CMR Versius platform in colorectal surgery. New devices will need more clinical development to be comparable to the current standard.

New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario?

“…The reported cases belonged to several specialties: hepatopancreatobiliary surgery [13, 37-39,50-55,78,79,87-97,100-103] (Tables S1 and S2), colorectal surgery [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][88][89][90][91][93][94][95][96][97][98][104][105][106][107][108][109][110][111] (Tables S1 and S3), abdominal wall surgery [11,12,[47][48][49][87][88][89][90][93]…”

“…Forty-five (43.7%) authors reported the surgical background of the operating surgeon and his previous experience [26,31,33,45,[47][48][49][50][51][52][53][54][55][56][57][58][59]62,64,67,69,76,77,79,[83][84][85][86][87][88][89][90][91][92]94,96,99,[102][103][104][105][106][108][109][110]. A structured training process of the surgical team on the adopted system was reported by 28 (27.2%) authors [26,40,[47][48][49]…”

Operative efficiency: a comparative analysis of Versius and da Vinci robotic systems in abdominal surgery

“…Versius is a novel robot that slightly differs from the standard of other robotic systems, leading to extra precautionary measures to be taken to decrease the fighting and clashing of instruments [ 7 ].…”

“…Also, the positions of bedside units (BSUs) were found to limit the assistant surgeon from having a proper position, which led to uncomfortable adjustments when performing high-risk tasks. Another point found within this study is that the platform’s dexterity was not optimal due to missing certain anatomical structures while adjusting the directions of the instruments [ 7 ]. However, the flexibility of the bedside units provided increased flexibility in port placement, which has reduced the learning curve, making the initial experience with such a system preferable [ 8 – 10 ].…”

Towards Truly “Bespoke” Robotic Surgery: Vessel-Sparing Sigmoidectomy

“…We wish to stress the importance of detecting the avascular plane between Told and Gerota fascia, just after the opening of the Jonnesco fold and the incision of the Monk line. 3 IMA is dissected free dividing sigmoid arteries (usually 3) at their origin. Similarly, sigmoidal veins are dived at their confluence into IMV.…”