FIRST SERIES WITH THE NEW ROBOTIC ENDO-WRIST STAPLERS FOR DA VINCI XI IN ANTERIOR RECTAL RESECTION FOR CANCER: A CASE-CONTROL COMPARISON WITH TRADITIONAL LAPAROSCOPIC STAPLERS

Background: The new robotic linear stapler, available for the Da Vinci Xi, is a new device directly controlled by the surgeon at the console and equipped with an Endo-Wrist technology. Our study aims to compare the operative and short-term results of the first group of patients undergoing an anterior rectal resection with total mesorectal excision (TME) for cancer, with the Da Vinci Xi and the new staplers, versus a comparable group in which we used the traditional laparoscopic staplers. Methods: From December 2015 to July 2016, fifteen patients underwent an anterior rectal resection with TME for cancer, using the robotic Endo-Wrist 45 mm staplers (group Xi-RobSTAP) at our multidisciplinary robotic center. The results were compared, using a case-control methodology, with a similar pool of patients who performed the same type of intervention with the use of a 60 mm traditional laparoscopic endo-stapler, applied by the bed-side assistant (Xi-TradSTAP group). A diverting ileostomy was fashioned in 13 patients of each group. Results: No need to convert to laparoscopy or laparotomy in both groups. There were no significant differences in the two groups in mean operative time (315±59.2 min RobSTAP Xi group versus 295±60.8 min Xi-TradSTAP group, p=0.3). In Xi-RobSTAP group we used a mean of 2.1±0.2 charges versus a mean of 2.9±0.5 in Xi-TradSTAP group (p=0.001). The rates of intra-operative complications and the average hospital stay were similar (7.5±2.7 days in Xi-RobSTAP group versus 6.8±1.3 days in the Xi-TradSTAP group; p= 0.5). During the follow up period, anastomotic fistula at contrast enema (not symptomatic except for one case of Xi-TradSTAP group ), was higher in the Xi-TradSTAP group, although without statistically significance (3 leak versus 1 leak in the Xi-RobSTAP group; p=0.15). Time elapse between rectal resection and stoma closure as well, was shorter in the Xi-RobSTAP group (4.2±3.1 month in Xi-TradSTAP and 2.7±2.1 month in Xi-RobSTAP group; p=0.17), although not statistically significant. Conclusion: In our preliminary experience the new robotic linear staplers seemed to give some advantages in terms of easy transection that could result in a reduction of average number of stapler firing used during rectal resection and with a lower incidence of anastomotic leakage. These promising data are very preliminary and need to be verified on a larger experiences.