Use of the Xi robotic platform for total abdominal colectomy: a step forward in minimally invasive colorectal surgery

Abstract

Background-The use of the da Vinci robotic platform for total colectomy has been limited by the need to reposition the patient-side surgical cart from one side of the patient to the other, which increases operative time. In this study we examined the feasibility of robotic total colectomy using the da Vinci Xi model, which offers a rotating boom-mounted system and laser-targeted trocar positioning. Methods-The study cohort consisted of 23 patients who underwent minimally invasive total colectomy for cancer or polyposis syndromes at a comprehensive cancer center between 2015 and 2017. Of the 23 colectomies, 15 were robotic and 8 were laparoscopic. For the robotic colectomies, trocars were placed in the supraumbilical region and all four quadrants. The da Vinci Xi robot was placed between the patient's legs, and the boom was rotated from left to right and then to the middle in order to work sequentially on the right colon, the left colon, and the pelvis. Operating time and short-term outcomes were compared between the patients who underwent robotic surgery and the patients who underwent laparoscopic surgery. Results-The two groups of patients were comparable in age, gender, BMI, physical status, and disease types. In the robotic group, median length of stay (4 vs. 6 days, p = 0.047) was significantly shorter and median operative time (243 vs. 263 min, p = 0.97) and median estimated blood loss (50 vs. 100 ml; p = 0.08) were similar between the groups. Conclusions-With the da Vinci Xi boom-mounted system, total abdominal colectomy can be performed without the need to move the patient-side surgical cart, and is associated with shorter length of stay and similar operative time compared to the laparoscopic approach.

Robotic multiquadrant colorectal procedures: A single-center experience and a systematic review of the literature

“…The 23 selected studies were published between 2004 and 2021; they consisted of 15 cohort studies ( 2 , 7 , 28 – 40 ) and 8 case series ( 1 , 41 – 47 ). All had a retrospective design.…”

“…Of the comparative studies, ten papers and three conference abstracts compared robotic and laparoscopic procedures; three papers were matched case-control studies ( 31 , 36 , 37 ), and ten were cohort studies ( 2 , 7 , 28 – 30 , 32 – 35 , 38 – 40 ). One cohort study compared robotic to open procedures ( 33 ), and another compared robotic with laparoscopic and open procedures ( 34 ).…”

“…Seven studies analyzed 371 robotic TC procedures ( 1 , 2 , 7 , 29 , 34 , 39 , 40 ) ( Table 4 ). Most interventions (334; 92%) were described in a retrospective study based on a national database with little information on the technique and the surgical platform.…”

“…Despite this heterogeneity, the overall evidence is based on a not negligible sample, accounting for more than 10,600 patients who underwent a robotic or laparoscopic procedure, suggesting that minimally invasive surgery for multiquadrant colorectal resections is widespread and acceptable. This evolution may be also linked to the introduction of the da Vinci Xi surgical system, characterized by the boom-mounted arms and the ability of the boom to rotate and provide access to all four abdominal quadrants with a single cart positioning (7)(8)(9). Most totally robotic procedures used the da Vinci Xi system with a single docking approach.…”

“…Nowadays, robotic colorectal surgery is widely used, and evidence supports its safety and efficacy compared to laparoscopic surgery ( 3 , 4 ). Despite its large applications ( 5 , 6 ), there is limited data on the use of robotic surgical platforms for extended colorectal resections requiring access in all four quadrants of the abdomen ( 7 ) mainly because, to achieve this by robotics, a repositioning of the patient-side robotic cart is needed, leading to an increased operative time and workload ( 7 , 8 ). The last generation of robotic platforms allows the rotation of the robotic cart without the need for robot repositioning, and thus it may favor the performance of multiquadrant procedures ( 7 , 9 ).…”