Control Comparison of the New EndoWrist and Traditional Laparoscopic Staplers for Anterior Rectal Resection with the Da Vinci Xi: A Case Study.

Abstract

Background: A new robotic stapler for the da Vinci Xi® is directly controlled by the surgeon at the console and equipped with EndoWrist® technology. We evaluated operative and short-term results of the first patients who underwent anterior rectal resection for cancer with the da Vinci Xi and new staplers, and compared the results with those of a comparable group treated with traditional laparoscopic staplers. Methods: From December 2015 to December 2017, 25 patients underwent anterior rectal resection for cancer with robotic EndoWrist staplers (EndoWrist group). Using a case-control method, we compared the results with those of a similar group of patients treated with the same system and a traditional laparoscopic endostapler, controlled by a bedside assistant (Control group). Results: No conversions to laparoscopy or laparotomy were observed, in either group. The mean number of charges was 2.1 ± 0.2 in the EndoWrist group versus 2.7 ± 0.7 in the Control group (P = .0004). The other perioperative results were comparable. During follow-up, the incidence of anastomotic fistula in a contrast enema study was higher in the Control group, although the difference was not statistically significant (two leaks versus two leaks in EndoWrist group; P = .8). The interval between rectal resection and stoma closure was shorter in the EndoWrist group (3.4 ± 2.5 versus 4.2 ± 2.9 months in the Control group; P = .2), although the difference was not significant. Conclusions: Our experience suggests that the new robotic staplers simplify transection, which could reduce the average number of stapler firings used during rectal resection and could decrease the incidence of anastomotic leakage. These findings require confirmation in larger studies.

• Authors: Simone Guadagni, Gregorio Di Franco, Desirée Gianardi, Matteo Palmeri, Cristina Ceccarelli, Matteo Bianchini, Niccolò Furbetta, Giovanni Caprili, Cristiano D'Isidoro, Andrea Moglia, Franca Melfi, Piero Buccianti, Franco Mosca, Luca Morelli
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 28 Issue 12 Pg. 1422-1427 (Dec 2018) ISSN: 1557-9034 [Electronic] United States
• PMID: 29920142 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Anastomosis, Surgical (methods)
• Anastomotic Leak (prevention & control)
• Female
• Humans
• Laparoscopy (methods)
• Male
• Proctectomy (methods)
• Rectal Neoplasms (surgery)
• Retrospective Studies
• Robotic Surgical Procedures (methods)
• Surgical Staplers
• Suture Techniques (instrumentation)