Does Advancing Technology Improve Outcomes? Comparison of the Da Vinci Standard/S/Si to the Xi Robotic Platforms During Robotic Nephroureterectomy

Patel, Manish; Hemal, Ashok K.

doi:10.1089/end.2017.0477

Cited by 41 publications

(17 citation statements)

References 13 publications

(12 reference statements)

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“…The reduction of the OT has influenced in turn reduction in PC because of a lower Operative Room (OR) hours. Our observation is in line with those recently report by Patel et al in urology, that revealed in a comparative study with the da Vinci Si, that the da Vinci Xi robotic nephroureterectomy reduced overall HC due to the reduction of anaesthesia and OR cost [37]. The significant reduction of the CC, was mainly due to the higher number of full robotic operations achieved with the da Vinci Xi, because it avoids the use of laparoscopic instruments and devices for the laparoscopic phase used in the hybrid technique.…”

Section: Discussionsupporting

confidence: 93%

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

et al. 2018

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The authors declare that no funding support was received for this study. Background Robotic-assisted surgery by the da Vinci Si appears to benefit rectal cancer surgery in selected patients, but still has some limitations, one of which is its high costs. Preliminary studies have indicated that the use of the new da Vinci Xi provides some added advantages, but their impact on cost is unknown. The aim of the present study is to compare surgical outcomes and costs of rectal cancer resection by the two platforms, in a single surgeon's experience. Methods From April 2010 to April 2017, 90 robotic rectal resections were performed, with either the da Vinci Si (Si-RobTME) or the da Vinci Xi (Xi-RobTME). Based on CUSUM analysis, two comparable groups of 40 consecutive Si-RobTME and 40 consecutive Xi-RobTME were obtained from the prospectively collected database and used for the present retrospective comparative study. Data costs were analysed based on the level of experience on the proficiency-gain curve (p-g-curve) by the surgeon with each platform. Results In both groups, two homogeneous phases of the p-g-curve were identified: Si1 and Xi1: cases 1-19, Si2 and Xi2: cases 20-40. A significantly higher number of full RAS operations was achieved in the Xi-RobTME group (p<0.001). A statistically significant reduction in operating time (OT) during Si2 and Xi2 phase was observed (p<0.001), accompanied by reduced overall variable costs (OVC), personnel costs (PC) and consumable costs (CC) (p<0.001). All costs were lower in the Xi2 phase compared to Si2 phase: OT 265 vs. 290 min (p=0.052); OVC 7983 vs. 10231.9 (p=0.009); PC 1151.6 vs. 1260.2 (p=0.052), CC 3464.4 vs. 3869.7 (p<0.001). Conclusions Our experience confirms a significant reduction of costs with increasing surgeon's experience with both platforms. However, the economic gain was higher with the Xi with shorter OT, reduced PC and CC, in addition to a significantly larger number of cases performed by the fully robotic approach.

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Section: Discussionsupporting

confidence: 93%

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

et al. 2018

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“…No specific exclusion criteria were used beyond case order as previously described. A 40-case cutoff was selected a priori according to literature regarding the multi-platforms comparison study [14] The first 40 consecutive RARP were performed using the da Vinci standard between December 2009 and May 2011 at the University of Udine, Italy. These were the first cases performed by the surgeon as an attending following completion of a 1-year minimally invasive urology fellowship.…”

Section: Patient Cohortmentioning

confidence: 99%

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

et al. 2021

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To describe perioperative outcomes following robot-assisted prostatectomy performed by a single surgeon during transitions between da Vinci standard/Si/Xi and the single port. Perioperative data were retrospectively evaluated of the first 40 consecutive robot-assisted radical prostatectomies performed by a single surgeon using the da Vinci standard, Si, Xi and single port. A total of 160 patients were included. We matched standard vs Si (Match 1), Si vs Xi (Match 2) and Xi vs single port (Match 3) cohort. Mann–Whitney and Fisher’s tests were used to test the difference among the groups. Univariate and multivariate logistic regression analyses were adopted to evaluate the predictors of overall and major complications. Single-port procedures in Match 3 showed significant shorter median operative time than Xi. Both Si and single-port groups showed significantly less median blood loss, a shorter median length of stay, respectively, than standard group in Match 1 and than Xi group in Match 3. 1 standard group patient required conversion to open surgery for an unsolvable conflict of the robotic arms. No other intraoperative complications were noted. On univariate and multivariate analyses, the da Vinci platform model was not a predicting factor of major complications (Clavien–Dindo ≥ 3). We described how technological progress impacted peri and postoperative outcomes during transitions between robotic surgical platforms for radical prostatectomy. In particular, the technological improvements associated to the increased surgeon’s expertise made the transition to the single port safe and effective when compared with previous platforms.

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“…Despite this, the difference with the robotic one was of only 26 min which could be a consequence of the robot docking or repositioning during the procedure. In fact, a recent comparative study on RNU performed with Xi platform demonstrated OT to be shorter of about 50 min [19], as the advantage of this new platform is to smoothly perform the entire procedures without need for re-docking or patient repositioning [20]. Unfortunately, there were no other studies available to perform a sensitivity analysis on this point.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

et al. 2019

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Purpose To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. Methods A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. Results Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI − 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. Conclusions Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined. Keywords Open radical nephroureterectomy • Hand-assisted radical nephroureterectomy • Laparoscopic radical nephroureterectomy • Robotic radical nephroureterectomy • Upper tract urothelial carcinoma Electronic supplementary material The online version of this article (

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Does Advancing Technology Improve Outcomes? Comparison of the Da Vinci Standard/S/Si to the Xi Robotic Platforms During Robotic Nephroureterectomy

Cited by 41 publications

References 13 publications

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

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