Protyniak Bogdan, Jorden Jeffrey, Farmer Russell
General Surgery, Geisinger Health System, 1000 E. Mountain Blvd., Wilkes-Barre, PA, 18711, USA.
Division of Colon and Rectal Surgery, University of Louisville, ACB2, Surgery Suite, 550 South Jackson Street, Louisville, KY, 40202, USA.
J Robot Surg. 2018 Mar;12(1):67-74. doi: 10.1007/s11701-017-0689-x. Epub 2017 Mar 8.
The newly introduced da Vinci Xi Surgical System hopes to address the shortcomings of its predecessor, specifically robotic arm restrictions and difficulty working in multiple quadrants. We compare the two robot platforms in multiquadrant surgery at a major colorectal referral center. Forty-four patients in the da Vinci Si group and 26 patients in the Xi group underwent sigmoidectomy or low anterior resection between 2014 and 2016. Patient demographics, operative variables, and postoperative outcomes were compared using descriptive statistics. Both groups were similar in age, sex, BMI, pelvic surgeries, and ASA class. Splenic flexure was mobilized in more (p = 0.045) da Vinci Xi cases compared to da Vinci Si both for sigmoidectomy (50 vs 15.4%) and low anterior resection (60 vs 29%). There was no significant difference in operative time (219.9 vs 224.7 min; p = 0.640), blood loss (170.0 vs 188.1 mL; p = 0.289), length of stay (5.7 vs 6 days; p = 0.851), or overall complications (26.9 vs 22.7%; p = 0.692) between the da Vinci Xi and Si groups, respectively. Single-dock multiquadrant robotic surgery, measured by splenic flexure mobilization with concomitant pelvic dissection, was more frequently performed using the da Vinci Xi platform with no increase in operative time, bleeding, or postoperative complications. The new platform provides surgeons an easier alternative to the da Vinci Si dual docking or combined robotic/laparoscopic multiquadrant surgery.
新推出的达芬奇Xi手术系统希望解决其前身的缺点,特别是机械臂限制以及在多个象限操作的困难。我们在一家大型结直肠转诊中心比较了这两种机器人平台在多象限手术中的表现。2014年至2016年期间,达芬奇Si组的44例患者和Xi组的26例患者接受了乙状结肠切除术或低位前切除术。使用描述性统计方法比较了患者的人口统计学特征、手术变量和术后结果。两组在年龄、性别、体重指数、盆腔手术和美国麻醉医师协会(ASA)分级方面相似。与达芬奇Si相比,无论是乙状结肠切除术(50%对15.4%)还是低位前切除术(60%对29%),达芬奇Xi病例中脾曲游离的比例更高(p = 0.045)。达芬奇Xi组和Si组之间的手术时间(219.9对224.7分钟;p = 0.640)、失血量(170.0对188.1毫升;p = 0.289)、住院时间(5.7对6天;p = 0.851)或总体并发症(26.9%对22.7%;p = 0.692)均无显著差异。通过脾曲游离并伴有盆腔清扫来衡量的单平台多象限机器人手术,使用达芬奇Xi平台的频率更高,且手术时间、出血或术后并发症均未增加。新平台为外科医生提供了一种比达芬奇Si双平台或机器人/腹腔镜联合多象限手术更简便的选择。