Robotic rectal cancer surgery: Results from a European multicentre case series of 240 resections and comparative analysis between cases performed with the da Vinci Si and Xi systems

Abstract

Robotic systems are designed to address the limitations of laparoscopic surgery, leading to a growing interest in robotic rectal surgery. However, certain technical limitations associated with the previous systems (da Vinci S & Si) have arguably slowed down its wholesale adoption. The latest robotic platform, the da Vinci Xi, addresses these limitations. This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems. All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases. The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed. A total of 240 patients were identified (124 Si, 116 Xi). Median operation-time and length-of-stay were 260 minutes and 6 days respectively. Conversion and 30-day mortality rates were 0. The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group (230 vs 300 min, p = 0.000) but length-of-stay, lymph node yield and circumferential resection margin favoured the Xi group (7 vs 5 days, p = 0.010; 17 vs 21, p = 0.000; 92.7% vs 99.1%, p = 0.020). Single-docking fully-robotic rectal cancer surgery is safe, feasible and can lead to good short-term outcomes, making it a good alternative to laparoscopic rectal cancer surgery. The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.