Results of the implementation of crossover docking of the da Vinci Si robotic system for rectal resection

• Goncharov A.L.
• Chicherina M.A.
• Aslanyan A.S.
• Muratov I.I.
• Khorobrykh T.V.
• Bedzhanyan A.L.
• Galliamov E.A.

Abstract

The placement of robotic arms and trocars when performing rectal resection can cause conflict of the instruments and urge for laparoscopic assistance. The development of proper docking system for robotic rectal resection is relevant.

Aim. To compare perioperative results of the use of ‘cross-over’ and the standard version of docking when performing robot-assisted rectal resection.

Material and methods. A single-center retrospective non-randomized study included 104 patients with adenocarcinoma of the rectum and rectosigmoid junction who underwent rectal resection with anastomosis using the da Vinci Si robotic system from 2017 to 2024. All patients were divided in two groups: 75 patients with ‘cross-over’ type docking and 29 patients with standard robotic docking.

Results. Complete mobilization of the splenic flexure was performed in 50 (66.7%) cases in the ‘cross-over’ docking group, and in 16 (55.2%) cases in the standard docking group (p=0.27). Laparoscopic assistance mobilization of the splenic flexure was required in 4 (5.3%) cases in the ‘cross-over’ docking group and in 5 (17.2%) cases in the standard docking group (p=0.52). The number of two-staged ‘cross-over’ docking was 24 (32%). Significant intraoperative instrument conflicts were recorded in 10 (13.3%) cases in the ‘cross-over’ docking group and in 9 (31%) cases in the standard docking group (p=0.06). There were 23 (22.1%) postoperative complications: 18 (24%) in the ‘cross-over’ docking group and 5 (17.2%) in the standard docking group (p=0.45).

Conclusion. The use of a ‘cross-over’ version of the robotic docking system such as the da Vinci Si to perform rectal resection increases the possibility of mobilization from the pelvic floor to the splenic flexure, reducing the need for a ‘hybrid’ approach with a low level of instrument conflict.

Keywords: robotic surgery; docking; rectal resection

References

1. Lakkis Z., Panis Y. Is there any reason not to perform standard laparoscopic total mesorectal excision? Clin Colon Rectal Surg. 2017; 30 (5): 333–8. DOI: https://doi.org/10.1055/s-0037-1606110
2. Panteleimonitis S., Harper M., Hall S., Figueiredo N., Qureshi T., Parvaiz A. Precision in robotic rectal surgery using the da Vinci Xi system and integrated table motion, a technical note. J Robot Surg. 2018; 12 (3): 433–6. DOI: https://doi.org/10.1007/s11701-017-0752-7
3. Park E.J., Cho M.S., Baek S.J., et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg. 2015; 261 (1): 129–37. DOI: https://doi.org/10.1097/SLA.0000000000000613
4. Rutegard M., Svensson J., Segelman J., et al. Splenic flexure mobilization and anastomotic leakage in anterior resection for rectal cancer: a multicentre cohort study. Scand J Surg. 2023; 112 (4): 246–55. DOI: https://doi.org/10.1177/14574969231181222
5. Polovinkin V.V., Pryn’ P.S. Mobilization of splenic flexure — routine or selective (results of a single-center randomized study). Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal named after I. Pirogov]. 2022; (7): 33–44. DOI: https://doi.org/10.17116/hirurgia202207133 (in Russian)
6. Intuitive Surgical. Annual Report 2023. URL: https://isrg.intuitive.com/static-files/e9ed7c14-f042-4923-b7cc-a1458e11e67
7. Luca F., Cenciarelli S., Valvo M., et al. Full robotic left colon and rectal cancer resection: technique and early outcome. Ann Surg Oncol. 2009; 16 (5): 1274–8. DOI: https://doi.org/10.1245/s10434-009-0366-z
8. Huang C.W., Tsai H.L., Yeh Y.S., et al. Robotic-assisted total mesorectal excision with the single-docking technique for patients with rectal cancer. BMC Surg. 2017; 17 (1): 126. DOI: https://doi.org/10.1186/s12893-017-0315-x Epub 2017 Dec 5.
9. Ahmed J., Nasir M., Flashman K., Khan J., Parvaiz A. Totally robotic rectal resection: an experience of the first 100 consecutive cases. Int J Colorectal Dis. 2016; 31 (4): 869–76. DOI: https://doi.org/10.1007/s00384-016-2503-z

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)