Systematic review of operative outcomes of robotic surgical procedures performed with endoscopic linear staplers or robotic staplers

Mario Gutierrez,Richard Ditto,Sanjoy Roy

doi:10.1007/s11701-018-0822-5

Abstract

A comprehensive review of operative outcomes of robotic surgical procedures performed with the da Vinci robotic system using either endoscopic linear staplers (ELS) or robotic staplers is not available in the published literature. We conducted a literature search to identify publications of robotic surgical procedures in all specialties performed with either ELS or robotic staplers. Twenty-nine manuscripts and six abstracts with relevant information on operative outcomes published from January 2011 to September 2017 were identified. Given the relatively recent market release of robotic staplers in 2014, comparative perioperative clinical outcomes data on the performance of ELS vs. robotic staplers in robotic surgery is very sparse in the published literature. Only three comparative studies of surgeries with the da Vinci robotic system plus ELS vs. da Vinci plus robotic staplers were identified; two in robotic colorectal surgery and the other in robotic gastric bypass surgery. These comparative studies illustrate some nuances in device design and usability, which may impact outcomes and cost, and therefore may be important to consider when selecting the appropriate stapling technologies/technique for different robotic surgeries. Comparative perioperative data on the use of ELS vs. robotic staplers in robotic surgery is scarce (three studies), and current literature identifies both types of devices as safe and effective. Given the longer clinical history of ELS and its relatively more robust evidence base, there may be trade-offs to consider before switching to robotic staplers in certain robotic procedures. However, this literature review may serve as an initial reference for future research.

Highlights

Stapling is a critical step during many surgical procedures involving the transection of vessels as well as other types of tissue—irrespective of the surgical approach
Staple line integrity is critical to creating a functional anastomosis or a clean transection and has been the focus of continuing innovation by surgical stapler manufacturers [1]
In most robotic surgical procedures performed in the last decade, the portion of the procedure requiring tissue stapling has been performed by a bedside surgeon/assistant using conventional endoscopic linear staplers (ELS)

Summary

Introduction

Stapling is a critical step during many surgical procedures involving the transection of vessels as well as other types of tissue—irrespective of the surgical approach. Staple line integrity is critical to creating a functional anastomosis or a clean transection and has been the focus of continuing innovation by surgical stapler manufacturers [1]. Staple line failure resulting in postoperative leaks is one of the most serious and feared complications for any surgery. Many studies acknowledge that surgeon experience is critical in creating an anastomosis with sufficient staple line integrity to resist leakage and promote healing [3–5]. In most robotic surgical procedures performed in the last decade, the portion of the procedure requiring tissue stapling has been performed by a bedside surgeon/assistant using conventional endoscopic linear staplers (ELS). Starting from the initial mechanically actuated devices, innovation in endoscopic stapling technology has introduced powered devices (available since 2010), which utilize a motor for both staple firing and knife blade action

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