The New Robotic Endowrist Stapler and the Bluetooth Integrated Table Motion for the Da Vinci XI: A Combined Right Colectomy and Partial Nephrectomy

Aim: The da Vinci Xi has been developed to overcome some of the limitations of the previous platform. New accessories devices have been released to further improve outcomes, especially the da Vinci Integrated Table Motion (dV-ITM), for the multiple organ surgery, and the robotic EndoWrist staplers which allows the surgeon to control directly from robot console all the steps of the surgical suture. We present a case of combined robot-assisted right colectomy and partial nephrectomy for a mesorenal right kidney tumor, with the use of these devices for the da Vinci Xi. Methods: A 78-year-old man with an adenocarcinoma of the right colon and a TC findings of a mesorenal right kidney tumor was operated with the da Vinci Xi platform. The patient was placed in a supine position and we used four robotic trocars positioned as suggested by the Intuitive for the "right quadrants". Results: The procedure was successfully completed in 320 min. The patient's position was changed three times during surgery, without un-docking the robot and with the instruments left inside the abdomen thanks to the dV-ITM. Initially, the patient was placed 15° tilted to the left and in Trendelemburg position for the isolation of the ileocolic vessels. Then the inclination was reduced for the right colic flexure mobilization. The patient was again placed in Trendelemburg position to complete the right colon resection and the right partial nephrectomy. Both the transverse colon and the last ileal loop resections, together with the ileocolic anastomosis were performed by using the robotic EndoWrist stapler. The defect was then closed with a double layer of running suture. Partial nephrectomy was performed with isolation and clamping of the right renal artery. No external collision or other problems related to the operating bed was noted. There were no surgical complications. The postoperative course was uneventful and the patient was discharged from hospital after 5 days. Conclusions: In our experience, the da Vinci Xi in combination with the use of the dV-ITM and the EndoWrist stapler can offer some advantages. In particular the robotic linear stapler which notes the suitable thickness between the branches and which can be articulated with a range of 108° allowed the operator to directly control all the transection/anastomosis steps of the operation; the dV-ITM allowed to move the patient without undocking the robotic platform, and resulted in a simplification of the workflow of this combined surgical procedure