ROBOTIC COMBINED HYSTERECTOMY AND RIGHT COLECTOMY USING THE DA VINCI Xi AND THE INTEGRATED TABLE MOTION

Background: Da Vinci Xi® represents the latest innovation for clinical use of robotic surgery that is supposed to give advantages in complex operations due to its new architecture, camera and instruments shafts. We present a combined approach for hysterectomy and right hemicolectomy using the new platform and its specific operating bed that work together with surgical cart via Bluetooth technology. Materials and methods: A 72-years old woman with high grade intraepithelial squamous lesion of the cervix and severe dysplasia polyp of the ascending colon was operated on with five trocar oblique arrangements using new platform. The table was moved three times during surgery: the first during hysterectomy placing the patient in 30° Trendelenburg position; the second and the third during the right hemicolectomy. The bed was tilted 10° to the left for vascular pedicle ligation and right colon mobilization, and then, leaving the bed tilted 10° to the left, a reverse Trendelenburg was realized, for right flexure mobilization and for intra-corporeally ileo-colonic anastomosis. We performed two targeting and turned the boom 180° from the pelvis to the right upper quadrant. Results: The procedure was successfully completed in 235 min. The pelvis, the lower and upper right quadrants were reached easily only with a re-docking of the platform after hysterectomy. The patients position was changed throughout the intervention with instruments inside the abdomen and no problems were noted. No conversion or additional trocar’ were required. The patient was discharge 5 days after surgery. Conclusions: Combined and multi-quadrant surgery is safe and effective technique that exploits the potentiality of the Da Vinci Xi® during the whole intervention achieving the advantages of conventional laparoscopy. The new robot combined with its specific table may facilitate the widespread diffusion of robotic minimally invasive technique also in difficult cases, overcoming limitations of previous systems