Si Robotic System Research Articles

Comparison of short-term outcomes of robotic-assisted radical colon cancer surgery using the Kangduo Surgical Robotic System and the Da Vinci Si Robotic System: a prospective cohort study.

Robotic surgery has been a revolution for colon cancer (CC) patients, with the increasing availability of different competitive robotic systems, but evidence of relevant oncologic outcomes is indeed scarce. Our goal was to compare the surgical quality and short-term oncologic outcomes of the Kangduo Surgical Robotic System and the da Vinci Si Robotic System in patients with CC. These are results from a subcohort of a multicenter randomized controlled noninferiority trial performed in three centers in China. Enrolled patients were randomly assigned to undergo surgery using either the KD-SR-01 system (KD group) or the da Vinci Si (DV) robotic system (DV group). Neither investigators nor patients were masked to treatment allocation, but assessment of pathological outcomes was masked to treatment allocation. The primary endpoint was surgical success rate. The secondary endpoints were surgical outcomes, pathologic outcomes, and postoperative outcomes. The study is registered at www.chictr.org.cn (ChiCTR2200063172). Although the long-term follow-up results were not a predefined endpoint for this study, late-stage work is in progress. A total of 58 CC patients were included in this study, 28 in the KD group and 30 in the DV group. All patients were successfully operated without any intermediate open/conventional laparoscopic surgery and the success rate of surgery was 100%. Assessment of equipment docking task load and intraoperative operating sensation score were similar between the two groups. Adverse events and Clavien-Dindo grade II or higher grade complication rates were comparable between the two groups. Device arm docking time, robotic arm operation time, and intraoperative bleeding were not significantly different between the two groups. Similar results were obtained from postoperative pathological outcomes and internal environment indexes. The efficacy and safety of the Kangduo Robotic Surgical System has been proved, operation of the Kangduo Robotic System by experienced surgeons for CC is not less effective than the da Vinci robotic System.

First Robot-Assisted Ivor Lewis Operation with Manual Intrapleural Anastomosis for Corrosive Esophageal Stricture

Introduction. Esophageal pathology constitutes a small share in general morbidity, however, it remains highly relevant due to its social and clinical significance. Corrosive strictures account for a large proportion among benign esophageal diseases. Treatment of the disease starts with intraluminal surgery. However, it provides only short-term effect due to the tendency of esophageal strictures to restenosis. In case of treatment failure, esophagoplasty is performed. The esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis was performed in the BSMU Clinic. The abdominal and thoracic phases were performed using Da Vinci Si robotic surgical system. By the time of publication of this paper, the authors have gained experience of 15 successfully performed surgeries of this kind.Materials and methods. The paper presents a clinical case of robot-assisted esophagoplasty according to Ivor Lewis performed on patient Y., born in 1978, with the clinical diagnosis: corrosive strictures of the lower third of the esophagus with dysphagia of III–IV degree. The pathology developed as a result of surrogate alcohol consumption in September 2017. Since October 2017, the patient has been regularly treated in the Thoracic Surgery Unit of the BSMU Clinic, where she underwent a number of endoscopic surgeries, which appeared to provide a little effect. The patient underwent a subsequent surgical treatment including esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis using Da Vinci Si robotic system.Results and discussion. First three days of the postoperative period, the patient remained in the Anaesthesiology and Intensive Care Unit. She received step-by-step parenteral and enteral nutrition. Control fl uoroscopic examinations revealed timely, disturbances-free evacuation and no contrast leakage from the formed anastomosis. The patient was discharged on day 11 in satisfactory condition.Conclusion. Using Da Vinci robot-assisted system in Lewis esophageal plastic surgery has a number of specific features. It provides more precise tissue extraction with preservation of stomach and esophageal vessels, moreover, mobility of the instruments enables the key phase to be performed, namely — manual suturing in the esophagoanastomosis. As a result, the risk of postoperative complications is reduced.

Robot-assisted cystectomy in treatment of patients with bladder urothelial carcinoma

The article presents an assessment of the results of surgical treatment of bladder urothelial carcinoma using the Da Vinci Si robotic system. The experience of treating 11 patients who underwent robot-assisted cystectomy (RACE) was analysed. This study demonstrates the effectiveness of RACE due to minimal trauma, blood loss, transfusion frequency, and length of patient stay in the hospital.

Comparison of the learning curve of robot-assisted and laparoscopic-assisted gastrectomy.

Da Vinci robot technology is widely used in clinic,with minimally invasive surgery development. This study aims to explore the possible influence of advanced surgical robotics on the surgery learning curve by comparing the initial clinical learning curves of 2 different surgical techniques: robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG). From September 2017 to December 2020, a chief surgeon completed a total of 108 cases of radical gastric cancer from the initial stage, including 27 cases of RAG of the Da Vinci Si robotic system (RAG group) and 81 cases of LAG (LAG group). The lymph node of gastric cancer implemented by the Japanese treatment guidelines of gastric cancer. The surgical results, postoperative complications, oncology results and learning curve were analyzed. There was no significant difference in general data, tumor size, pathological grade and clinical stage between the 2 groups (P>0.05). The incidence of serious complications in the RAG group was lower than the LAG group (P=0.003). The intraoperative blood loss in the RAG group was lower than that in the LAG group (P=0.046). The number of lymph nodes cleaned in the RAG group was more (P=0.003), among which there was obvious advantage in lymph node cleaning in the No.9 group (P=0.038) and 11p group (P=0.015). The operation time of the RAG group was significantly longer than the LAG group (P=0.015). The analysis of learning curve found that the cumulative sum analysis (CUSUM) value of the RAG group decreased from the 10th case, while the CUSUM of the LAG group decreased from the 28th case. The learning curve of the RAG group had fewer closing cases than that of the LAG group. The unique design of the surgical robot might help to improve the surgical efficiency and shorten the surgical learning curve. Advanced robotics helps experienced surgeons quickly learn to master RAG skills. With the help of robotics, RAG are superior to LAG in No.9 and 11p lymph node dissection and surgical trauma reduction. RAG can clear more lymph nodes than LAG, and has better perioperative effect.

Experience of reconstructive plastic robot-assisted surgery in patients with isthmocele after cesarean section

BACKGROUND: According to several Russian researchers, the number of cesarean deliveries in different regions of Russia varies from 15.2% to 42%. The incidence of complications inconsistency of the uterine scar (isthmocele) after surgery is 10%15%.
 AIM: This study aimed to assess the efficiency and safety of robot-assisted surgery in the correction of isthmoceles after cesarean section in patients of reproductive age.
 MATERIALS AND METHODS: The study involved seven patients aged 2734 years with signs of isthmoceles after urgent or elective cesarean section 12 months to 6 years prior to hospitalization. A comprehensive dynamic examination (echography, magnetic resonance imaging, and office hysteroscopy), surgical treatment with the da Vinci Si robotic complex, and outpatient monitoring in the early and long-term period (1, 6, 12, 24, and 36 months) were performed.
 RESULTS: The patients were satisfied with the results of surgical treatment during outpatient monitoring due to the improved quality of life resulting from the reduction of pathological symptoms. The control echography (1, 6, and 12 months later) showed normal myometrial thickness (911 mm) and adequate blood flow in the metroplasty area in all patients. The niche was not visualized during office hysteroscopy 6-months after the metroplasty. Three patients became pregnant 1620 months after the reconstructive uteroplasty and ended with a timely operative delivery. Two patients were followed up for their pregnancies at 12 and 29 weeks of gestation, while two women continued taking oral contraceptives and planned their next pregnancy at least a year later.
 CONCLUSIONS: The use of the da Vinci Si robotic system for surgical correction of isthmoceles provides volumetric three-dimensional visualization of anatomical structures, reduces the duration of surgery and intraoperative blood loss, minimizes the number of intraoperative and postoperative complications, and contributes to accelerated postoperative rehabilitation of patients.

Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results.

Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.

Transition from da Vinci to Versius robotic surgical system: initial experience and outcomes of over 100 consecutive procedures.

We sought to describe the development of the robotic urology program at Sindh Institute of Urology and Transplantation (SIUT) and the feasibility of transitioning from the da Vinci to Versius robotic systems. The SIUT robotics program began in 2017 utilizing the da Vinci Si robotic system, transitioning to the Versius system in 2021. Retrospective review of our quality assurance database was performed. All procedures performed utilizing the two systems were identified, analyzed, and compared. Data were described with descriptive statistics. Matched procedures (by type of procedure) performed by the same surgeons utilizing the da Vinci and Versius were compared. All tests were double-sided with statistical significance set at p < 0.05.106 cases were performed by the Versius robotic surgical system in 2021. Median age was 42years (IQR 26-56), and 69 (65%) were males. Procedures included both benign (83%) and malignant disorders (17%), several upper tract (75%), and pelvic/lower tract (25%). No major intraoperative complications were observed. Conversion to open occurred in six procedures. Malfunction of the robotic arms occurred in two procedures: the erroneous bedside units (BSU) were replaced. Eight patients developed postoperative high-grade complications. Matched analysis of various procedures (pyeloplasty, stone surgery, radical, partial, and simple nephrectomy) showed no significant difference in perioperative outcomes. To our knowledge, this is the first and largest series of urologic procedures performed by the Versius robotic surgical system.

New Technique for Introducing a Surgical Stapler during Robot-Assisted Lobectomy for Lung Cancer.

The da Vinci Si version robot lacks a vascular stapler that can be controlled by the operating surgeon at the surgical console when dividing pulmonary vessels. Therefore, to initiate and safely perform robotic anatomical lobectomy for lung cancer, it is important to develop a safe method for introducing a surgical stapler. We performed a retrospective study of the first 42 consecutive patients who underwent robotic lobectomy for lung cancer at Nippon Medical School Hospital between January 2019 and December 2020. Up to case 18, we performed robot-assisted thoracoscopic surgery (RATS) lobectomy by using a four-arm approach with two assistant ports. For dividing pulmonary vessels, the surgical stapler was introduced through the assist ports. However, since this is not the port position usually used in video-assisted thoracoscopic surgery (VATS), there were many difficult situations. For RATS lobectomy case 19 and all subsequent cases, we utilized a total port approach that uses three robotic arms and two assistant ports. To resect the pulmonary vessels or bronchi with endoscopic staplers, the port for the robotic arm was removed and the endoscopic staplers were placed through a 12-mm Xcel bladeless port. This change reduced operation time, blood loss, and robotic arm interference. No patient developed intraoperative complications during RATS lobectomy. The present total port approach, with three robotic arms, appears to be feasible for introducing surgical staplers during RATS with the da Vinci Si robotic system.

Is roboticda Vinci Xi® superior to the da Vinci Si® for sphincter-preserving total mesorectal excision? Outcomes in 150 mid-low rectal cancer patients.

The aim of this study was to determine the superiority between the robotic da Vinci Si® (Si group) and da Vinci Xi® (Xi group) generation in patients with mid-low rectal cancer. Between December 2011 and December 2017, 88 patients with mid-low rectal cancer were operated on using the Si robotic system, from January 2018 to May 2021, 62 more patients with mid-low rectal cancer were operated on using the Xi robotic system. Perioperative and postoperative short-term outcomes were compared between the two groups. Univariate and multivariate Cox-regression analysis were performed to determine factors affecting operating time. A cumulative sum (CUSUM) analysis was also performed to determine the learning curve of the primary surgeon. All patients underwent sphincter saving total mesorectal excision (TME). The overall operating time was significantly shorter in the Xi group (181.3 ± 31.8min in Si group vs 123.6 ± 25.7min in the Xi group, p < 0.001). There were no significant differences in terms of conversion rates, mean hospital stays, complications and histopathologic data. CUSUM analysis show completion of learning curve in 44th case of Si group. Univariate and multivariate analysis demonstrated that the learning curve of the primary surgeon (p < 0.001) and the type of robotic system (Xi) are only two factors associated with operating time (OR, 95% CI p; 3.656, 0.665-9.339, p < 0.001). Our study found that the robotic da Vinci Xi systems provide significantly shorter operating time comparing with Si systems, when performing sphincter-preserving TME in mid-low rectal cancer patients. Surgical system (da VinciXi) and primary surgeon learning curve are two independent risk factors which associated shortened operating time.Postoperative complication rates and histopathologic outcomes are similar in both groups.

Extraperitoneal Robotic Laparo-Endoscopic Single-Site Plus1-Port Radical Prostatectomy Using the da Vinci Single-Site Platform.

Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.

Training in robotic surgery: initial experience using the Brazilian College of Surgeons model.

to present the initial experience of the first tier of surgeons trained in the new model of robotic surgery training proposed by the CBC. we retrospectively collected data and information on training with the Da Vinci SI robotic system. The variables analyzed were, in the pre-clinical phase, time of completion of each step by surgeon and number of hours in the simulator, and in the clinical phase, operations carried out by the training group, number of surgeons who performed nine procedures in ninety days ("9 in 90"), time of docking, time of console, and results surgical. we interviewed 39 surgeons before training started; 20 (51.3%) reached the clinical phase. The average age of surgeons was 47.9 years (38-62). The average time between the first interview and the delivery of the online certificate was 64 days (15-133). The surgeons have made an average of 51h and 36 minutes of robot simulation (40-83 hours). The total number of cases in which the training surgeons participated as first assistant was 418, with an average of 20.9 per surgeon. The time of pre-clinical training had an average of 116 days (48-205). the new model proposed had good acceptance by all surgeons trained and proved safe in the initial sample.

Surgical effect and long-term clinical outcomes of robotic mitral valve replacement: 10-year follow-up study.

To assess the safety and effectiveness, clinical experience with totally robotic mitral valve replacement (TE-MVR) for treating valvular heart disease was summarized and analyzed, and patients' recovery conditions were followed-up. The clinical data of 47 patients who received TE-MVR in our hospital between October 2008 and December 2015 were retrospectively analyzed. Among the patients, there are 26 men and 21 women. The mean age was 47.53±10.80 years. We followed up the transesophageal echocardiography (TTE) data of post-discharge patients and analyzed the operation results to determine the surgical effects of TE-MVR. The surgeries were mainly performed with the da Vinci Si robotic surgical system. Thirty-five mechanical valves and twelve bioprosthetic valves were implanted. The cardiopulmonary bypass and aortic cross-clamping times were 122.02±25.45 min and 85.68±20.70 min, respectively. There was no operative mortality. The perioperative complication could only be found in one case, which was pleural effusion. All the TTE results were satisfying before discharge. No paravalvular leakage or prosthetic valve dysfunction was detected. All 47 patients were discharged successfully. During the long-term follow-up (28-110 months), 42 patients were followed-up (89.4%). Most of their heart function was NYHA class I and II. The postoperative TTE showed that the left atrial diameter and left ventricle diameter were decreased (P<0.01). TE-MVR is reliable and effective, and the postoperative follow-up results revealed good heart function. Patients will obtain benefits from TE-MVR, such as small trauma and rapid recovery. Thus, it is a good minimally-invasive surgery of choice.

Robotic surgery in gynecology: review of literature.

Robotic surgery carries with it the potential to transform laparoscopic surgery by providing, for the 1st time, instruments with distal ends that mimic the intricate movements of the human hand while at the same time providing the surgeon with a high-definition, three-dimensional view of the operative field. To describe the clinical application of robotic surgery in benign gynecological conditions, as well as the components of the Da Vinci Si robotic system, analyzing the advantages and disadvantages of this type of surgical approach that it provides to the patient and in turn to the surgeon. Review of the literature in PubMed and UpToDate where the keywords of our review were searched. Inclusion criteria: Articles of cases or series containing the sections of the application of robotic surgery in gynecology and clinical results. We found 50 scientific articles that included in their titles the key words of our review. 22 articles were discarded, 14 because they were inaccessible, 3 because they were published in bulletins without an impact factor and 5 because no information was obtained about the researcher's results, their volume, visibility and structure. A total of 28 articles were chosen for this review. Robotic surgery has evolved to be a separate field, with enormous potential for future development. The results show until now that this technology is applicable and capable of offering an adequate treatment to selected patients.

Impact of Refractive Errors on Da Vinci SI Robotic System.

Objective:To investigate the impact of refractive errors on binocular visual acuity while using the Da Vinci SI robotic system console.Methods:Eighty volunteers were examined on the Da Vinci SI robotic system console by using a near vision chart. Refractive errors, anisometropia status, and Fly Stereo Acuity Test scores were recorded. Spherical equivalent (SE) were calculated for all volunteers' right and left eyes. Visual acuity was assessed by the logarithm of the minimal angle of resolution (LogMAR) method. Binocular uncorrected and best corrected (with proper contact lens or glasses) LogMAR values of the subjects were recorded. The difference between these values (DiffLogMAR) are affected by different refractive errors.Results:In the myopia and/or astigmatism group, uncorrected SE was found to have significant impact on the DiffLogMAR (p < 0.001) and myopia greater than 1.75 diopter had significantly higher DiffLogMAR values (p < 0.05). Subjects with presbyopia had significantly higher DiffLogMAR values (p < 0.01), and we observed positive correlation between presbyopia and DiffLogMAR values (p = 0.33, p < 0.01). The cut off value of presbyopia that correlated the most with DiffLogMAR differences was found to be 1.25 diopter (p < 0.001). In 13 hypermetropic volunteers, we found significant correlation between hypermetropia value and DiffLogMAR (p > 0.7, p < 0.01). The statistical analysis between Fly test and SE revealed a significant impact of presbyopia and hypermetropia to the stereotactic view of the subject (p = −0.734, p < 0.05).Conclusion:Surgeons suffering from myopia greater than 1.75 diopter, presbyopia greater than 1.25 diopter (D), and hypermetropia regardless of grade must always perform robotic surgeries with the proper correction.

Robotic inguinal hernia repair: is technology taking over? Systematic review and meta-analysis

To examine the current evidence on the therapeutic role and outcomes of robotic Transabdominal Preperitoneal Inguinal hernia repair (rTAPP) to better define its risk-benefit ratio and guide clinical decision-making. PubMed, EMBASE, and Web of Science were consulted. A Frequentist single-arm study-level random effect meta-analysis was performed. Twelvestudies published between 2015 and 2018 met the inclusion criteria (1645 patients). Patients' age ranged from 16 to 96, the BMI ranged from 19 to 35.6kg/m2, and 86.1% were males. Unilateral hernia repair was performed in 69.6% while bilateral hernia repair was performed in 30.4% of patients. The operations were all conducted using the da Vinci Xi or Si robotic system (Intuitive Surgical, Inc., Sunnyvale, CA, USA). The rTAPP was successfully completed in 99.4% of patients and the operative time ranged from 45 to 180.4min. The postoperative follow-up ranged from 16 to 368days. The estimated pooled prevalence of intraoperative complications and conversion were 0.03% (95% CI 0.00-0.3) and 0.14% (95% CI 0.0-0.5%), respectively. The estimated pooled prevalence of urinary retention, seroma/hematoma, and overall complications were 3.5% (95% CI 1.6-5.8%), 4.1% (95% CI 1.6-7.5%), and 7.4% (95% CI 3.4-10.9%). The estimated pooled prevalence of hernia recurrence was 0.18% (95% CI 0.00-0.84%). Robotic technology has been progressively entering surgical thinking and gradually changing surgical procedures. Based on the results of the present study, the rTAPP seems feasible, safe, and effective in the short term for patients with unilateral and bilateral inguinal hernias. Further prospective studies and randomized controlled trials are needed to validate these findings.

A live porcine model for robotic sacrocolpopexy training.

Robotic sacrocolpopexy is an effective and durable technique for pelvic organ prolapse repair. However, the learning curve for this procedure has underscored the need for an effective surgical training module. Given the cost, infection risk, poor tissue compliance, and scarcity of human cadavers, the live porcine model represents a realistic, available, and cost-effective alternative. This article describes a live porcine model for teaching robotic sacrocolpopexy to determine whether it teaches key aspects of live human robotic sacrocolpopexy to the learner. This robotic sacrocolpopexy model was created using the Da Vinci Xi or Si robotic system on domestic pigs under general anesthesia. The main steps of the model include: (1) creating the porcine "cervix" and (2) performing robotic sacrocolpopexy. The model was evaluated with a survey given to 18 board-certified surgeons who attended the training course between December 2016 and April 2018. All of the participants reported improvements in their economy of motion, tissue handling ability, suturing efficiency, and overall performance of robotic sacrocolpopexy. Furthermore, a majority of participants were likely to incorporate aspects of the model into their practice (88.8%) and recommend the model to colleagues (94.2%). The porcine model provides a feasible tool for teaching robotic sacrocolpopexy to physicians.

Robotic pancreaticoduodenectomy with right hepatic artery resection

Background: Pancreaticoduodenectomy(PD) with en bloc hepatic arterial resection and reconstruction remains a controversial topic. Although use of robotic surgery has been increasing worldwide in patients requiring PD, hepatic arterial resection and reconstruction has not been previously described. This video depicts a first in utilizing the Davinci Si robotic system to perform a hepatic arterial vascular resection and anastomosis during PD. Methods: A 69 year-old female, presenting with obstructive jaundice, was diagnosed with a distal common bile duct cancer by ERCP and brushing cytology. CT scan imaging revealed the suspected tumor mass involving the proximal right hepatic artery. We performed a total robotic PD. Right hepatic artery (RHA) was involved by the tumor and segmental resection was performed to achieve en bloc resection. End-to-end anastomosis of RHA stump to distal part was carried out by using 5-0 proline suture robotically. The reconstruction, including the modified Blumgart fashion pancreatojejunostomy, choledochojejunostomy and gastrojejunostomy, were all accomplished intracorporeally using the robotic platform. Results: The total operative time was 499 minutes and estimated blood loss was 500ml. The patient was discharged on post-OP day 4 without complications. The final pathology was moderately differentiated pancreatic adenocarcinoma with extensive perineural invasion. Metastatic carcinoma was found in one of the ten lymph nodes. Conclusion: PD with hepatic artery resection and reconstruction can be performed safely using robotic surgery. Restoration of the resected hepatic artery may ensure the bilio-enteric anastomosis in the immediate and late post-operative course.

Colorectal Cancer Surgery Using the Da Vinci Xi and Si Systems: Comparison of Perioperative Outcomes.

Robotic surgery for colorectal cancer is an emerging technique. Potential benefits as compared with the conventional laparoscopic surgery have been demonstrated. However, experience with the previous da Vinci Si robotic system revealed several unsolved problems. The novel features of the new da Vinci Xi increase operational flexibility and maneuverability and are expected to facilitate the performance of multiquadrant surgery. Between December 2011 and May 2015, 120 patients with colon or rectal cancer were operated on using the Si robotic system (the Si group). Between May 2015 and October 2017, 60 more patients with colon or rectal cancer were operated on using the Xi robotic system (the Xi group). The clinicopathological characteristics and perioperative outcomes of these 2 groups of patients were compared. The 2 groups of patients were comparable with regard to baseline clinical characteristics, types of resection performed, and the proportion of patients undergoing neoadjuvant chemoradiation therapy. The statuses of resection margin, the numbers of lymph nodes harvested, and the rates of postoperative complications were also similar between the 2 groups. Nevertheless, a lower rate of diverting ileostomy, a shorter operation time, less estimated blood loss, and a faster postoperative recovery was observed in the Xi group. Colorectal cancer surgery using the Xi robotic system was associated with improved perioperative outcomes. These benefits may be attributed to its improved, more user-friendly design.

Validation of a Simulation-training Model for Robotic Intracorporeal Bowel Anastomosis Using a Step-by-step Technique

ObjectiveTo develop and validate a training model for the robotic intracorporeal bowel anastomosis. MethodsFor simulation, surgeons with varying levels of experience were instructed about bowel anastomosis robotic surgical simulation in a short educational video. All participants performed the required steps for the intracorporeal bowel anastomosis under standardized conditions. The procedure consists of the following steps: division of the bowel with a stapler (1), incision and opening of the bowel limbs at the antimesenteric angle (2), insertion of the stapler into the 2 bowel limbs for the side-to-side anastomosis (3), and transverse closure of the anastomosis with the stapler (4). All simulations were performed using the daVinci SI robotic system. Face and content validity were assessed using a standardized questionnaire. Construct validity was evaluated using the Global Evaluative Assessment of Robotic Skills, a validated global performance rating scale. ResultsTwenty-two surgeons participated including 6 robotic experts and 16 trainees. The expert participants rated the bowel anastomosis model highly for face validity (median 4/5; 64% agree or strongly agree), and all participants rated the content as a training model very highly (median 4.5/5; 100% agree or strongly agree). Discrimination between experts and trainees using Global Evaluative Assessment of Robotic Skills demonstrated construct validity (novice 17.6 vs expert 24.7, P = .03). ConclusionWe demonstrate that the bowel anastomosis robotic surgical simulator is a reproducible and realistic simulation that allows for an objective skills assessment. We establish face, content, and construct validity for this model. This step-by-step technique may be utilized in training surgeons desiring to acquire skills in robotic intracorporeal urinary diversion.

Technical and operational modifications required for evolving robotic programs performing anatomic pulmonary resection.

The objectives of this study are to review the complicated and often confusing technical changes required when converting from the Si robotic system to the Xi when performing pulmonary lobectomy and segmentectomy. We reviewed a prospective database of a consecutive series of patients who intended to undergo robotic lobectomy or segmentectomy by one surgeon. There were 101 lobectomies and 25 segmentectomies performed on the Si robot in 2015-2016, and 95 lobectomies and 28 segmentectomies in 2016 on the Xi robot. The two groups were similar for age, height, weight, pulmonary function, anatomic resections, and co-morbidities. Technical differences in robotic arm numbering, port placement, and instrumentation are shown below. Median docking time was shorter with the Xi robot [7.5 (95% CI 6-8) versus 10 (95% CI 9-12) min, p=0.003] as was operation duration [114 (95% CI 104-123) versus 119 (95% CI 116-126) min, p=0.041] and skin closure to room exit [12 (95% CI 10-24) versus 13 (95% CI 12-15) min, p=0.081]. Anesthesiologists expressed greater comfort with the Xi system, because the patient's head was not covered by the robot. Outcomes for Si and Xi operations such as median blood loss (20cc versus 20cc), transfusion rate (0 versus 0), major complication rate (3.2 versus 3.3%), and the 30- and 90-day mortality were no different (one 30-day death in the Si group). The technical changes that are required for robotic Si-to-Xi conversion are shown. The Xi system may offer improved operational efficiency.