Desirée Gianardi

Full Robotic Colorectal Resections for Cancer Combined With Other Major Surgical Procedures: Early Experience With the da Vinci Xi

Background. The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiorgan surgery. Methods. Between January 2015 and October 2015, 10 patients with synchronous tumors of the colorectum and others abdominal organs underwent robotic combined resections with the da Vinci Xi. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for “left lower quadrant,” with trocars centered on the umbilical area, or shifted 2 to 3 cm to the right or to the left, depending on the type of combined surgical procedure. Results. All procedures were completed with the full robotic technique. Simultaneous procedures in same quadrant or left quadrant and pelvis, or left/right and upper, were performed with a single docking/single targeting approach; in cases of left/right quadrant or right quadrant/pelvis, we performed a dual-targeting operation. No external collisions or problems related to trocar positions were noted. No patient experienced postoperative surgical complications and the mean hospital stay was 6 days. Conclusions. The high success rate of full robotic colorectal resection combined with other surgical interventions for synchronous tumors, suggest the efficacy of the da Vinci Xi in this setting.

Robotic Colorectal Resection With and Without the Use of the New Da Vinci Table Motion: A Case-Matched Study

Background. The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM. Methods. Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group). Results. Overall robotic operative time was shorter in the Xi-dVTM group (P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group (P = .024). Conclusions. In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.

AB010. S010. Pancreatic cystic lesions’ follow-up with abdominal ultrasound scan: could it play an alternative role to the routine use of MRI?

Background: Pancreatic cystic lesions (PCL) without “worrisome features” (WFs) at the time of diagnosis, usually necessitate a lifetime surveillance. The routine follow-up in these cases comprises a magnetic resonance imaging (MRI) scan every 6 months in the 1st year, then annually for the next 5 years. Since these parameters can also be evaluated with an abdominal ultrasound scan (AUS), we studied the safety, feasibility and economic impact of AUS follow-up, with a delayed use of MRI. Methods: We retrospectively evaluated all patients who had been followed-up with AUS for the presence of “low risk” PCL. All of patients underwent to an AUS every 6 months for the 1st year and then, in case of stable disease, annually from the 2nd to the 5th year. A surveillance MRI scan was routinely executed every 2 years, or according to the presence of considerable modifications at AUS. We compared the two methods regarding sensitivity and specificity in identifying cysts variations. We also focused on a costs-analysis between the theoretical application of the international guidelines follow-up with MRI, and our follow-up strategy with AUS and delayed MRI. Results: Two hundred patients were followed-up with AUS between January 2012 and January 2016 for PCL. Mean follow-up period was 25.1±18.2 months. Surgery was required for 2 patients (1%), due to the appearance of WF at imaging [with concordance among ultrasonography (US) and MRI]. During the follow-up, AUS showed “low grade” modifications in 28 patients (14%), comprising main pancreatic duct dilatation <6 mm and increasing of the main cyst of about 0.5 cm, compared to previous examinations. In all of these cases MRI confirmed AUS findings, without adding more prognostic information. In only 11 patients (5.5%) a routine MRI identified an evolution of the lesions, not showed at AUS, but only related to an increased number of the PCL (P=0.14). Nevertheless, a MRI every 6 months would not have changed in any case the decisional process. The mean cost of surveillance for each patient, in a theoretical application of international guidelines with MRI at our group of patients, should have been 402€±273.7€, while according to our follow-up strategy it was 215.4€±212.6€ (P<0.0001). Conclusions: In patients with PCL without WF, AUS, could be a safe alternative to MRI, reducing the numbers of 2nd level examinations and therefore reducing costs. Long term safety of this approach should be validated on a longer follow-up period, with a larger series of patients and prospective studies.