Similar Operative Outcomes between the da Vinci Xi^® and da Vinci Si^® Systems in Robotic Gastrectomy for Gastric Cancer

Abstract

Purpose The robotic system for surgery was introduced to gastric cancer surgery in the early 2000s to overcome the shortcomings of laparoscopic surgery. The more recently introduced da Vinci Xi ® system offers benefits allowing four-quadrant access, greater range of motion, and easier docking through an overhead boom rotation with laser targeting. We aimed to identify whether the Xi ® system provides actual advantages over the Si ® system in gastrectomy for gastric cancer by comparing the operative outcomes. Materials and Methods We retrospectively reviewed all patients who underwent robotic gastrectomy as treatment for gastric cancer from March 2016 to March 2017. Patients' demographic data, perioperative information, and operative and pathological outcomes were collected and analyzed. Results A total of 109 patients were included in the Xi ® group and 179 in the Si ® group. Demographic characteristics were similar in both groups. The mean operative time was 229.9 minutes in the Xi ® group and 223.7 minutes in the Si ® group. The mean estimated blood loss was 72.7 mL in the Xi ® group and 62.1 mL in the Si ® group. No patient in the Xi ® group was converted to open or laparoscopy, while 3 patients in the Si ® group were converted, 2 to open surgery and 1 to laparoscopy, this difference was not statistically significant. Bowel function was resumed 3 days after surgery, while soft diet was initiated 4 days after surgery. Conclusions We found no difference in surgical outcomes after robotic gastrectomy for gastric cancer between the da Vinci Xi ® and da Vinci Si ® procedures.

Short- and long-term outcomes of totally robotic versus robotic-assisted radical distal gastrectomy for advanced gastric cancer: a mono-institution retrospective study

“…The intra-abdominal bleeding was dramatically decreased in TRDG group compared with RADG group (38.0 ± 18.5 ml vs. 85.6 ± 35.8 ml, p = 0.001) which is similar with a recent study [19]. This result was attributed to the superiority that da Vinci robotic-assisted surgical system can filter the physiologic tremor from surgeon and allows surgeon operate in a narrow space so that vascular damage is less.…”

Totally minimally invasive radical gastrectomy with the da Vinci Xi® robotic system versus straight laparoscopy for gastric adenocarcinoma

“…14 Surgeons may prefer to use the S or Si platforms over the Xi platform if they have more consolidated experience with them. Our results support the safety and feasibility of totally robotic approach with the da Vinci Xi® system in radical gastrectomy 13,14 .…”

“…Conversion rates varied between 0% and 12% in prior studies on robotic radical gastrectomy. 13,14 Two meta-analysis reported similar conversion rates in patients undergoing robotic versus laparoscopic radical gastrectomy for gastric cancer 13,15 . Unlike the literature, use of the da Vinci Xi ® robotic platform seems to provide some improvement in terms of decreased conversion rates compared to totally laparoscopic surgery in our series.…”

“…Conversion rates varied between 0% and 12% in prior studies on robotic radical gastrectomy 13,14 . Two meta‐analysis reported similar conversion rates in patients undergoing robotic versus laparoscopic radical gastrectomy for gastric cancer 13,15 .…”

The Present and Future of Robotic Gastrectomy

“…One major improvement was the integration of firefly fluorescence imaging, which aided surgeons to quickly switch to find target LNs and avoid structural damage [53]. Both Roux-en-Y gastric bypass and gastrectomy for gastric cancer proved that da Vinci Xi is as feasible as its conventional counterpart [53,54]. However, a longer time for docking in Xi was noted in both studies.…”