LOCALLY ADVANCED PANCREATIC CANCER TREATED WITH THE DA VINCI XI: A ROBOT-ASSISTED APPLEBY PANCREATECTOMY

Background: New technologies in surgery have greatly spread in recent decades, not only in open or laparoscopic surgery, but also and to a greater extent in the new surgical frontier of robotic surgery. We herein present a case of an anterior rectal resection performed using all the more recent innovations for the da Vinci Xi platform: the new wireless linked operating bed with Table Motion technology, the new robotic EndoWrist linear stapler and the indocyanine green fluorescence technology. Methods: A 78-years old man with an adenocarcinoma of the rectum underwent surgery with the da Vinci Xi platform after neoadiuvant short course radiotherapy. Trocars were placed according to the left lower quadrant trocars’ disposition suggested by Intuitive. Results: The operation was successfully completed in 245 minute. The patient’s position was changed two times during the procedure, with instruments left inside the abdomen and without undocking the robot. Patient’s position was first arranged for the inferior mesenteric vein, the splenic flexure and the descending colon mobilization and then for Total Mesorectal Excision. No external instrument collision or other problems related to the operating table were recorded. No surgical complications or need for conversion to laparoscopy or laparotomy occurred. Rectum section was performed with the new robotic linear staplers equipped with EndoWrist technology. Fire-fly indocyanine green fluorescence was also used to assess the anastomosis perfusion. The patient had an uneventful postoperative recovery and was discharged 8 days after surgery. Conclusion: The use of da Vinci Xi new technologies in our experience resulted in a simplification of the workflow, an easier rectal transaction and virtually an increased safety.