TECHNICAL ASPECTS AND POSTOPERATIVE OUTCOMES OF FULLY ROBOTIC COMBINATION PROCEDURES WITH DA VINCI XI: COLORECTAL RESECTION FOR CANCER ASSOCIATED WITH OTHER MAJOR SURGICAL PROCEDURES

Background/Hypothesis: The new Da Vinci Xi® has been developed to overcome some limitations of the previous version, facilitating the workflow during multi-quadrant procedures. In this study we evaluated the technical aspects and early outcomes of colorectal resections combined with other major abdominal surgical procedures. Materials and Methods: From January 2015 to October 2015, 10 patients underwent robotic colorectal surgery combined with other major surgeries. Examined variables were: demographic characteristics, preoperative data (position of the trocar, technical aspects, operative and docking time) and short term outcomes (average hospital stay and postoperative surgical complications). Colorectal resections were 5 hemicolectomy and 5 anterior resection of the rectum associated with a sigmoidectomy, a right nephrectomy, hysterectomy, 3 liver resection, enucleation of two distal lesions of the pancreas and ileum-colonic resection. In 3 cases it used the TruSystem 7000dV, specific operating table connected to Da Vinci Xi using wireless technology allowing the patient's movements with robotic instruments left inside. Results: All procedures were performed with a full robotic approach, without the need to change trocars’ or robotic cart position. Simultaneous procedures in the same quadrant or left quadrant and pelvis were performed with a single docking/single targeting approach; in case of left/right quadrant or right quadrant/pelvis we performed a double-docking and re-targeting operation. No external collision or other problems related to the operating bed was noted. The mean operative time was 360 min (± 128 min) and the average hospital stay was 6 days (± 3 days). There were no surgical or medical complications. Conclusions: Our initial experience suggests the efficacy of the new robotic platform Da Vinci Xi in minimally invasive multi-quadrant combined surgery. Additional advantages could be provided by the new integrated operating table allowing movements without the need to disconnect the robotic arms.