In experienced hands, does the robotic platform impact operative efficiency? Comparison of the da Vinci Si versus Xi rob
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ORIGINAL ARTICLE
In experienced hands, does the robotic platform impact operative efficiency? Comparison of the da Vinci Si versus Xi robot in colorectal surgery Ashley Hill1 · James McCormick2 Received: 14 November 2019 / Accepted: 15 February 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Robotic surgical platforms have aimed to assist surgeons in meeting the challenges accompanying minimally invasive colon and rectal surgical procedures. Since early adoption over decade ago, there has been an evolution of the robotic platforms aimed at improved usability. We hypothesize, when compared to da Vinci Si, the Xi will allow for greater efficiency and result in shorter operative times. A case log review was completed for a single colorectal surgeon with 7 years’ robotic experience, totaling over 800 cases. Patients were identified using CPT code S2900 (robot) for the most recent 15 months (January 2018–March 2019) contemporaneously at two tertiary care teaching hospitals; one equipped with the Si platform and the other with the Xi. A retrospective chart review of patients undergoing sigmoid colon resection or low anterior rectal resection (LAR) was completed. Categorical values were assessed using Fisher’s exact test or Chi-square tests. Continuous data was compared using unpaired t test. 158 patients were identified as undergoing robotic major colonic surgical resection. A total of 93 patients underwent robotic sigmoid resection or LAR and were grouped based on the robotic platform used (Si, n = 52 vs. Xi, n = 41). The Xi group had significantly shorter surgical times for LAR and sigmoid resection, 162 vs 238 min (p = 0.0001). In the hands of an experienced surgeon, the da Vinci Xi system results in shorter operative times when performing sigmoid resection or LAR compared to older platforms. The da Vinci Xi may allow for improved efficiency as reflected by shorter operative times. Keywords da Vinci Xi · da Vinci Si · Robotic surgery · Rectal cancer · Learning curve
Introduction Minimally invasive surgery has many proven clinical advantages [1–4]. Since the first laparoscopic colon resection in 1991, there has been rapid progression of technology and technique in the field [5]. Drawbacks of laparoscopic surgery include reliance on an assistant to handle the camera, assistance with retraction and limited range of motion with * James McCormick [email protected] Ashley Hill [email protected] 1
General Surgery Residency, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
Department of Colon and Rectal Surgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
2
non-articulating instruments. Robotic surgical platforms have aimed to aid surgeons in meeting the challenges that accompany minimally invasive colon and rectal surgical procedures. Since introduction nearly 2 decades ago, there has been an evolution of the robotic platforms towards improved usability. The da Vinci Xi is the fourth generation platform released from in
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