Abstract
Robotic rectal surgery is becoming increasingly more popular among colorectal surgeons. However, time spent on robotic platform docking, arm clashing and undocking of the platform during the procedure are factors that surgeons often find cumbersome and time consuming. The newest surgical platform, the da Vinci Xi, coupled with integrated table motion can help to overcome these problems. This technical note aims to describe a standardised operative technique of single docking robotic rectal surgery using the da Vinci Xi system and integrated table motion. A stepwise approach of the da Vinci docking process and surgical technique is described accompanied by an intra-operative video that demonstrates this technique. We also present data collected from a prospectively maintained database. 33 consecutive rectal cancer patients (24 male, 9 female) received robotic rectal surgery with the da Vinci Xi during the preparation of this technical note. 29 (88%) patients had anterior resections, and four (12%) had abdominoperineal excisions. There were no conversions, no anastomotic leaks and no mortality. Median operation time was 331 (249–372) min, blood loss 20 (20–45) mls and length of stay 6.5 (4–8) days. 30-day readmission rate and re-operation rates were 3% (n = 1). This standardised technique of single docking robotic rectal surgery with the da Vinci Xi is safe, feasible and reproducible. The technological advances of the new robotic system facilitate the totally robotic single docking approach.
Highlights
The increasing adoption of robotic rectal surgery is evident from the growing number of studies published on the subject [1–3]
We have developed a standardised technique for single docking robotic rectal surgery using the da Vinci Xi system, primarily based on a previously described laparoscopic technique [6] applied on the da Vinci Si® [7]
The new robotic platform by Intuitive Surgical comes with several technological advances that help overcome many of the difficulties encountered in robotic rectal surgery by its predecessors
Summary
The increasing adoption of robotic rectal surgery is evident from the growing number of studies published on the subject [1–3] This might be due to robotic systems offering superior three-dimensional views and advanced instrument ergonomics, enabling precise dissection in narrow spaces such as the pelvis [4, 5]. We have developed a standardised technique for single docking robotic rectal surgery using the da Vinci Xi system, primarily based on a previously described laparoscopic technique [6] applied on the da Vinci Si® [7]. In this technical note, we describe the technique using Xi system
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