Standardized access options for colorectal surgery with the da Vinci Xi system

Abstract

Performing colorectal surgery with previous da Vinci system generations presented some limitations that caused uncertainty for surgeons as they began to apply robotic technologies. The da Vinci Xi system is designed to overcome these limitations and to enable multiquadrant colorectal surgery. The design concept of the da Vinci Xi system and the standardized access for colorectal surgery are explained. The da Vinci Xi system applies an overhead boom that maximizes the arm workspace, minimizes interference and makes the port placement universal for standardized access. Colorectal approaches have been validated in numerous cadaver models confirming the reproducibility of the standardized access. Standardized access with astraight-line port placement is possible in all colorectal applications. For right-sided hemicolectomy, atransverse abdominal approach as well as asuprapubic port placement are possible. Utilizing the same principles, left-sided colectomy, sigmoid colectomy and low anterior resections can be performed. Proctocolectomy is enabled through boom rotation and asecond docking. Only minor arm-to-arm interferences occurred and were easily manageable by the bedside assistant. None of the approaches required rearrangement of the patient cart or swapping arms to different port locations. The da Vinci Xi system enables astandardized access for colorectal surgery through auniversal straight-line port placement. Learning this standard principle once enables the surgeon to apply it to all colorectal surgeries and shorten the learning curve as well as minimizing stress for both novices and experienced robotic surgeons learning anew surgical robotic platform.