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Da Vinci Xi, the fourth generation platform, was released in 2014 and introduced as the successor to the Si platform for minimal invasive surgery. We reviewed our experience with robotic-assisted adrenalectomy and compared peri-operative outcomes using the da Vinci robot model Xi vs. Si. Since June of 2014, 85 consecutive patients underwent robotic...
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Background
Minimally invasive surgery, such as laparoscopic adrenalectomy and robotic adrenalectomy, has become a treatment of choice for benign adrenal tumors. Efforts are ongoing to minimize the invasiveness of the procedure and to reduce the number of port sites. The primary endpoint of this study was the safety and feasibility of a reduced-port...
Citations
... Our results did not show the expected benefit of RAL over CL in terms of intra-and postoperative complications, estimated blood loss, number of rehospitalizations, or days spent in hospital, and we observed even longer operative times by approximately 30 min. The latter can be attributed to an average docking time of approximately 18.2 min [30]. Operating time was found to be the most significant factor associated with postoperative complications and length of postoperative hospital stay. ...
Background
Endometriosis is a chronic condition affecting 6–10% of women of reproductive age, with endometriosis-related pain and infertility being the leading symptoms. Currently, the gold standard treatment approach to surgery is conventional laparoscopy (CL); however, the increasing availability of robot-assisted surgery is projected as a competitor of CL. This study aimed to compare the perioperative outcomes of robot-assisted laparoscopy (RAL) and CL in endometriosis surgery.
Objectives
We aimed to compare the effectiveness and safety of these two procedures.
Methods
A systematic search was conducted in three medical databases. Studies investigating different perioperative outcomes of endometriosis-related surgeries were included. Results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI).
Results
Our search yielded 2,014 records, of which 13 were eligible for data extraction. No significant differences were detected between the CL and RAL groups in terms of intraoperative complications (OR = 1.07, CI 0.43–2.63), postoperative complications (OR = 1.3, CI 0.73–2.32), number of conversions to open surgery (OR = 1.34, CI 0.76–2.37), length of hospital stays (MD = 0.12, CI 0.33–0.57), blood loss (MD = 16.73, CI 4.18–37.63) or number of rehospitalizations (OR = 0.95, CI 0.13–6.75). In terms of operative times (MD = 28.09 min, CI 11.59–44.59) and operating room times (MD = 51.39 min, CI 15.07–87.72;), the RAL technique remained inferior.
Conclusion
RAL does not have statistically demonstrable advantages over CL in terms of perioperative outcomes for endometriosis-related surgery.
Graphical abstract
... In this context, although the Da Vinci Si and Xi are demonstrably the most utilized surgical platforms worldwide [6,7], urologic literature still lacks comparative evidence on surgical outcomes of these two robotic systems. In this regard, while there are currently no studies assessing the transition between these two robotic platforms with respect to robot-assisted partial nephrectomy (RAPN), only few investigations are available for robot-assisted radical prostatectomy (RARP), and these studies are often limited by the small sample size [4,8,9]. ...
Purpose
In the emerging field of robotics, only few studies investigated the transition between different robotic platforms in terms of surgical outcomes. We aimed at assessing surgical outcomes of patients receiving robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN) at a high-volume robotic center during the transition from Si to Xi Da Vinci surgical systems.
Methods
We analyzed data of 1884 patients undergoing RARP (n = 1437, 76%) and RAPN (n = 447, 24%) at OLV hospital (Aalst, Belgium) between 2011 and 2021. For both procedures, we assessed operative time, estimated blood loss, length of stay, and positive surgical margins. For RARP, we investigated length of catheterization and PSA persistence after surgery, whereas warm ischemia time, clampless surgery, and acute kidney injury (AKI) were assessed for RAPN. Multivariable analyses (MVA) investigated the association between robotic platform (Si vs. Xi) and surgical outcomes after adjustment for patient- and tumor-related factors.
Results
A total of 975 (68%) and 462 (32%) patients underwent RARP performed with the Si vs. Xi surgical system, respectively. Baseline characteristics did not differ between the groups. On MVA, we did not find evidence of a difference between the groups with respect to operative time (estimate: 1.07) or estimated blood loss (estimate: 32.39; both p > 0.05). Median (interquartile range [IQR]) length of stay was 6 (3, 6) and 4 (3, 5) days in the Si vs. Xi group, respectively (p < 0.0001). On MVA, men treated with the Xi vs. Si robot had lower odds of PSM (Odds ratio [OR]: 0.58; p = 0.014). A total of 184 (41%) and 263 (59%) patients received RAPN with the Si and Xi robotic system, respectively. Baseline characteristics, including demographics, functional data, and tumor-related features did not differ between the groups. On MVA, operative time was longer in the Xi vs. Si group (estimate: 30.54; p = 0.006). Patients treated with the Xi vs. Si system had higher probability of undergoing a clampless procedure (OR: 2.56; p = 0.001), whereas the risk of AKI did not differ between the groups (OR: 1.25; p = 0.4). On MVA, patients operated with the Xi robot had shorter length of stay as compared to the Si group (estimate: − 0.86; p = 0.003), whereas we did not find evidence of an association between robotic system and PSM (OR: 1.55; p = 0.3).
Conclusion
We found that the Xi robot allowed for improvements in peri-operative outcomes as compared to the Si platform, with lower rate of positive margins for RARP and higher rate of off-clamp procedures for RAPN. Hospital stay was also shorter for patients operated with the Xi vs. Si robot, especially after robot-assisted partial nephrectomy. Awaiting future investigations—in particular, cost analyses—these results have important implications for patients, surgeons, and healthcare policymakers.
... Robotic adrenalectomy has been successfully performed, and its safety and efficacy have been reported in several studies. With the advantages of the robotic system, such as a 3-dimensional view with a magnified camera and multi-articulated instruments, reducing the number of ports of PRA has become more feasible, and reduced 2-port and single-port PRA using the da Vinci systems are being performed successfully [5,[8][9][10]. ...
Background
This study demonstrates our experience of single-port robotic posterior retroperitoneal adrenalectomy (RPRA) using the da Vinci SP robot system and evaluates its technical feasibility and surgical outcomes.
Methods
We conducted a retrospective analysis of 250 RPRAs, including 117 conventional 3-port RPRAs, 103 reduced 2-port RPRAs, and 30 single-port RPRAs. Each RPRA type was compared by analyzing 30 patients in the early phase of surgery.
Results
All patients who underwent single-port RPRA showed excellent surgical outcomes. Age, sex, BMI, and tumor location site did not significantly differ between the three groups. In the early phase, the size of the adrenal tumor was similar between three groups, and it tended to increase as the number of ports increased (p < 0.001). The mean operation time was shorter for patients who underwent single-port RPRA than those who underwent RPRA types (p < 0.001). The numeric rating scale score did not significantly differ between the groups on most days. No major complications were observed, and no patients were converted to open surgery or required additional port insertion.
Conclusion
Single-port RPA using the da Vinci SP robotic system showed the effectiveness of the surgical procedure and improved cosmetic outcomes for patients, while also enabling surgeons to perform operations with greater ease and convenience. Therefore, single-port RPRA could be a good alternative option for the treatment of adrenal tumors in selected situations.
... At the same time, it can be adjusted as per specific circumstances such as large masses or particular anatomies. Furthermore, our trocar placement has been easily used with both da Vinci systems, with no modifications needed, similar to what reported by Feng et al. [18], who also reported no differences in terms of perioperative outcomes. ...
Objective
In the last years, robotic surgery was introduced in several different settings with good perioperative results. However, its role in the management of adrenal masses is still debated. In order to provide a contribution to this field, we described our step-by-step technique for robotic adrenalectomy (RA) and related modifications according to the type of adrenal mass treated.
Methods
We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital (Aalst, Belgium) between January 2009 and October 2022. Demographic, intra- and post-operative, and pathological data were retrieved from our prospectively maintained institutional database. Continuous variables are summarized as median and interquartile range (IQR). Categorical variables are reported as frequencies (percentages).
Results
Twenty-seven patients underwent RA were included in the study. Median age, body mass index, and Charlson's comorbidity index were 61 (IQR: 49–71) years, 26 (IQR: 24–29) kg/m², and 2 (IQR: 0–3), respectively, and 16 (59.3%) patients were male. Median tumor size at computed tomography scan was 6.0 (IQR: 3.5–8.0) cm. Median operative time and blood loss were 105 (IQR: 82–120) min and 175 (IQR: 94–250) mL, respectively. No intraoperative complications were recorded. Overall postoperative complications rate was 11.1%, with a postoperative transfusion rate of 3.7%. A total of 10 (37.0%) patients harbored malignant adrenal masses. Among them, 3 (11.1%) had adrenocortical carcinoma, 6 (22.2%) secondary metastasis, and 1 (3.7%) malignant pheochromocytoma on final pathological exam. Only 1 (10.0%) patient had positive surgical margins.
Conclusion
We described our step-by-step technique for RA, which can be safely performed even in case of high challenging settings as malignant tumors, pheochromocytoma, and large masses. The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.
... The fourth-generation da Vinci surgical system, the Xi platform, was introduced in 2014 and has been used in several complicated surgeries. [7][8][9][10][11][12][13] In contrast to the previous robot-assisted surgery systems, the da Vinci Xi system incorporates advancements such as a redesigned boom-mounted system and laser-guided docking assistance, reducing the technical difficulties associated with docking, targeting, and performing surgical procedures. Studies have compared the Xi system with the Si system for urologic and nonurologic surgeries. ...
... Most of these studies have focused on perioperative reports, including declined anesthesia and total operative and docking times. [7][8][9][10][11][12][13] Functional outcomes, complications, and oncologic outcomes following PN are key endpoints for evaluating the functionality of RAPN systems. [14] However, only a few previous studies have compared the short-and mid-term oncologic outcomes of RAPN procedures using the da Vinci Xi and Si platforms with limited sample sizes. ...
Purpose
Comparative studies on the outcomes of robot-assisted partial nephrectomy (RAPN) procedures conducted using the da Vinci Xi and Si platforms remain sparse. We retrospectively reviewed and compared the Trifecta and Pentafecta rates of the two robotic surgical platforms.
Materials and Methods
A total of 338 patients who had undergone RAPN using da Vinci Si platform or Xi platform were included. Pentafecta was defined herein as Trifecta (a warm ischemia time <25 min, a negative surgical margin, and the absence of significant perioperative complications) with the addition of estimated glomerular filtration rate preservation of over 90% and no chronic kidney disease stage progression by 12 months postsurgery. Multivariate logistic regression analysis was conducted to identify the predictors of Trifecta and Pentafecta achievement.
Results
The trifecta and pentafecta rates were higher in the Xi group than in the Si group (65% vs. 29%, P < 0.001 for trifecta; 31% vs. 14%, P = 0.001 for pentafecta). In addition, a significantly shorter average WIT (19 vs. 28 min, P < 0.001) and console time (141 vs. 163 min, P = 0.004) were identified in the Xi group than in the Si group. RAPN conducted using the Xi platform was independently associated with both higher achievement rates of trifecta and pentafecta. In addition, multivariate regression analyses revealed that no history of hypertension, low tumor complexity as measured using the RENAL nephrometry score, anterior orientation of the renal tumor were associated with higher Trifecta rates; while history of diabetes and anterior–posterior renal tumor orientation were the significant predictors of Pentafecta achievement, respectively.
Conclusion
A significantly higher rates of trifecta and pentafecta achievement were observed in the Xi group than in the Si group. The use of the Xi platform was also significantly associated with low operative times and acceptable complication rates.
... [3][4][5][6][7][8][9][10][11] In addition, it has been suggested that RA may have a benefit in large adrenal tumors (>6 cm), obese patients, and patients with previous abdominal surgery compared with LA. [12][13][14] Furthermore, RA for pheochromocytoma achieves better outcomes than LA in terms of safety and efficacy. 11 However, a major issue is the high cost of RA compared to LA and OA, 5,8,15 and the long-term oncological outcomes of RA are still unknown. 16 Although it is difficult to uniformly discuss medical costs because of the differences in medical systems in each country, some studies report the cost-effectiveness of robotic surgery by shortening the operation time, hospital stay, and reducing the number of robotic forceps. ...
... Several reports suggest that the problem with robotic surgery is its high cost compared to laparoscopic or open surgery; the same is true for RA. 5,8,15,17,19 Brandao et al. reported RA using three robotic forceps. 20 We agree that using more robotic forceps may be a safer approach to RA. ...
Minimally invasive adrenalectomy is the preferred technique for managing adrenal tumors. Laparoscopic adrenalectomy is widely performed and covered by insurance in Japan, but robot-assisted adrenalectomy is not. To investigate the best forceps combinations for performing robot-assisted adrenalectomy safely, we performed robot-assisted adrenalectomy for two left and two right adrenal adenomas using different robotic forceps combinations (bipolar forceps, monopolar curved scissors, Vessel Sealer Extend, and SynchroSeal) for each case. Although we evaluated a small number of RAs, lower blood loss was observed in patients where the vessel sealing devices were used. The extent of dissection is small for adrenalectomy, and robotic bipolar vessel sealing tools may not be necessary, especially for the small adrenal tumors. However, considering the risk benefits, the combination of forceps with Vessel Sealer Extend (by the left arm) and monopolar curved scissors (by the right arm) will become one of the best forceps combinations for performing robot-assisted adrenalectomy safely.
... However, this difference was explained as resulting from to the lack of patient repositioning for the ureteral dissection using the Xi system. Other comparisons for partial nephrectomy [20], adrenalectomy [21] and prostatectomy [22] demonstrated that the Xi system provided shorter docking and console time as compared to the Si system. [20][21][22] Given that the SP platform is a new technology, no similar studies have been reported using this system. ...
... Other comparisons for partial nephrectomy [20], adrenalectomy [21] and prostatectomy [22] demonstrated that the Xi system provided shorter docking and console time as compared to the Si system. [20][21][22] Given that the SP platform is a new technology, no similar studies have been reported using this system. ...
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.
... Schans et al. [10] compared 18 cases of partial nephrectomy with the Xi system and 18 cases of partial nephrectomy with the Si system and found that the docking time of the Xi system was significantly shorter than that of the Si system. Similar results have been demonstrated in a study of robot-assisted laparoscopic adrenalectomy [11]. In our study, the Xi system showed good docking ability, which is consistent with the results of the above studies, although this study focused on a different type of surgery from the above studies. ...
... However, the cost of robotic surgery with the Xi system varies among medical centers and may be higher or lower than that with the Si system. Therefore, the cost of robotic surgery with the Xi system should not be generally considered higher than with the Si system [11,14]. Nevertheless, the purchase and maintenance costs of the Xi system are higher than those of the Si system. ...
Background
To compare the perioperative and short-term efficacy and cost of the da Vinci Xi and da Vinci Si surgical systems for radical prostatectomy.
Methods
We retrospectively analyzed the clinical data of 175 patients with prostate cancer who underwent radical prostatectomy with the da Vinci Si or Xi surgical systems in our hospital from June 2019 to June 2020. Of the 175 patients, 82 underwent robot-assisted laparoscopic radical prostatectomy with the da Vinci Xi surgery system, and 93 patients underwent robot-assisted laparoscopic radical prostatectomy with the da Vinci Si surgical system. The perioperative outcomes, short-term efficacy and costs were compared between the two groups.
Results
The anesthesia time, operation time, docking time, indwelling catheter time and postoperative bed rest time in the Xi group were shorter than those in the Si group (respectively, 268.8 min vs. 219.3 min, P = 0.001; 228.2 min vs. 259.6 min, P < 0.001; 7.4 min vs. 12.7 min, P < 0.001; 8.6 d vs. 9.7 d, P = 0.036; 2.2 d vs. 2.6 d, P = 0.002). However, the total cost of hospitalization and the cost of intraoperative consumables in the Xi group were higher than those in the Si group (84,740.7 vs. 76,739.1 ¥, P = 0.003; 13,199.4 vs. 10,823.0 ¥, P = 0.019).
Conclusions
Although the cost of robot-assisted radical prostatectomy is higher, compared with the Si system, the Xi system has better perioperative outcomes and can provide similar short-term efficacy and oncology outcomes.
... Improved RCS technological development and a transition from DaVinci Si ® to the Xi ® model and a dedicated robotic team can reduce total operation time. Several studies have con rmed a reduction in both docking and total operating times using the DaVinci Xi ® model, with an average of 21 cases needed to reach a statistically signi cant reduction in the docking time (34)(35)(36). The technological development of RCS and the da Vinci Xi ® model's introduction allows the surgeon more freedom and the ability to perform even technically demanding procedures that previously have been di cult to perform laparoscopically. ...
Background
Robotic-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study's main objective was to compare short-term complications, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robotic-assisted.
Methods
We conducted a retrospective cohort study comparing the robotic-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume centre from May 2017 – March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response.
Results
Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robotic-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4–5) versus 5 days, interquartile range (4–7), p < 0.001) and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robotic-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.20, 95% confidence interval (1.04–1.40), p < 0.001). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery and surgical or medical short-term complications.
Conclusion
Robotic-assisted surgery is feasible and can be safely implemented for colorectal resections. The robotic-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short and long-term outcomes of robotic surgery for colorectal cancer.
... This is attributed to the one-step docking possible for the SP system and the 3 steps needed for the SS system (Fig. 1). Nevertheless, the experiences of the surgical team can shorten the docking time in robotic surgery [28]. Similarly, in our study, the docking time could be affected by the surgical experience. ...
Objective
The gold standard procedure for treating patients with apical pelvic organ prolapse (POP) is sacrocolpopexy. However, no report comparing the two types of single-incision robotic sacrocolpopexy, namely, single-site robotic sacrocolpopexy (SS-RSC) and single-port robotic sacrocolpopexy (SP-RSC) exists. Therefore, we compared the safety and effectiveness of SS-RSC and SP-RSC.
Materials and methods
In this study, 48 patients who underwent single-incision RSC, 40 non-consecutive patients who underwent SS-RSC, and 8 consecutive patients who underwent SP-RSC for symptomatic POP quantification stage III–IV and were eligible for the 1-year follow-up (FU) were included. We compared the surgical time and operative outcomes of SS-RSC and SP-RSC. We also compared the data of the initial 8 cases in each group.
Results
The mean patient age was 59.2 ± 11.0 years and 66.1 ± 8.0 years in the SS-RSC (n = 40) and SP-RSC (n = 8) groups, respectively. The mean operative time (OT) and console time were comparable between the SS-RSC and SP-RSC groups (135.3 ± 31.6 min vs 141.8 ± 23.5 min; 94.6 ± 32.2 min vs 89 ± 9.5 min, respectively). The docking time and cervix suturing time were short in the SP-RSC group (P < 0.05). However, in the analysis of the initial 8 cases in each group, all surgical times except the cervix suturing time were shorter in the SP-RSC group (P < 0.05). Three cases had intraoperative bladder injury (two [5.0%] in the SS-RSC and one [12.5%] in the SP-RSC group). Two cases (5.0%) had umbilical incisional hernia in the SS-RSC group. Two cases had vaginal mesh erosion on the posterior vaginal wall, with 1 case in each group. One case (2.5%) experienced a recurrence of POP; an anterior compartment POP-Q stage 2 following SS-RSC at the 4-week FU.
Conclusion
Single-incision RSC, both SS-RSC and SP-RSC, is a feasible and effective surgical option for treating symptomatic apical POP with an aesthetic finish.
