Early Experience with the da Vinci Xi Surgical System in Digestive Surgery

Monika E Hagen, Minoa K Jung, Leo Buehler, Christian Toso, Jassim Fakhro, Philippe Morel. University Hospital Geneva

Background: Robotic surgery has been developed to overcome some of the technical limitations of conventional laparoscopy and improved by different version of the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) over the past decades. While previous models including the da Vinci Standard, the S and the Si Surgical System have been successfully applied to a variety of procedures, continuous criticism has been raised regarding a complex set-up and the limited ability to operate in multiple abdominal quadrants, which might be a contributing factor in the currently limited use of robotic for abdominal surgeries. The da Vinci Xi Surgical System is the latest addition to the family of robotic systems for laparoscopy and was released in 2014. This system offers the same basic characteristics of the previous models including 3D vision, articulated instruments and software features, but also comes with an updated user-interface, re-designed robotic arms that offer a wider range of motion, longer instruments, and other specific features that are targeted to facilitate robotic set-up and multi-quadrant procedures.

Materials and Methods: Perioperative data of patients who underwent robotic surgery with the da Vinci Xi system within our first 6 month of experience was prospectively collected and analyzed.   

Results: Between March and September 2015, 55 patients underwent da Vinci Xi digestive surgery at our department. 46 foregut (41 Roux-en-Y gastric bypasses), 7 colorectal procedures (4 left- and 1 right-sided), 1 hepatic resection and 1 lymphadenectomy were performed. Mean operating time was 235.3 (+/-96.1) minutes with 229.4 (+/-84.3) minutes for gastric bypass procedures and 290.7 (+/-43.7) for colorectal procedures. Mean docking time was 8.7 (+/-4.0) minutes with no significant differences for upper gastro-intestinal and colorectal docking. The gastric bypass procedure was successfully transitioned from a hybrid approach to a fully robotic approach and all colorectal procedures (Right colectomy, sigmoid resection and low anterior resection) were finished with a single robotic docking without re-arrangement of robotic arms. 1 intra-operative and no postoperative complications occurred. 1 procedure was converted to conventional laparoscopy and 1 patient was re-operated due to a bleeding of the robotic stapling line of the remnant stomach of a gastric bypass procedure.

Conclusions: The da Vinci Xi Surgical System appears to enable the augmentation of robotic procedures for gastric bypass and colorectal surgery.  Further research is needed to clearly determine the role of the da Vinci Xi Surgical System for digestive surgery.