The Role of Integrated Table Motion for da Vinci Xi in Robotic Colo-Rectal Resections: A Comparative Study

Background: The Integrated Table Motion (ITM, Trumpf Medical, Ditzingen, Germany) is an advanced operating table wirelessly communicating with the da Vinci Xi surgical system that allow to reposition the patients with instruments inside the abdomen and without undocking the robot. The aim of our study is to compare operative and short-term outcomes of patients who underwent colorectal surgery for cancer with the da Vinci Xi system using the ITM, versus a control group of patients undergoing the same procedures without the use of the ITM.Materials and Methods: Ten patients underwent robotic colo-rectal resection for cancer (6 anterior rectal resection ARR, 1 intersphinteric rectal resection IRS, 2 right colectomy RC, 1 sigmoid resection SIG) with the use of ITM (Xi-ITM group) at our center between December 2015 and October 2016. The intraoperative and short-term results were compared, using case-control methodology. A propensity scores approach was performed to create 1:2 matched pairs (matching the Xi-ITM subjects to Xi-No-ITM subjects according to BMI, age, gender, ASA score and intervention type) using a caliper method algorithm. Independent t tests and χ2 test (or Fisher’s exact test) were performed to compare different variables. Results: Mean overall robotic operative time was significantly shorter in the Xi-ITM group (227 min versus 297 min, p= 0,04). All Xi-ITM cases were fully robotic, while conversion was needed in two Xi-No-ITM cases, because of bulky tumors and difficult exposure (0 vs 2, p=NS). Postoperative medical complications, all of grade I or II, were higher in Xi-No-ITM group (1 vs 11, p= 0,024).Conclusions: In our early experience the use of new Integrated Table Motion for da Vinci Xi resulted in a simplification of workflow. The possibility to change the patients position, without undocking the patient side cart or removing instruments, improves the exposure of operative fields, resulting in a reduced overall robotic operative time and could result in a lower conversion rate as well. The reduced use of extreme positions to gain optimal exposure of operative field could contribute to decrease the rate of postoperative medical complications due to a lesser hemodynamic and respiratory changes, or soft tissue injuries.