A Comparison between the da Vinci Xi Endowrist Stapler and a conventional Laparoscopic Stapler in Rectal Transection: A Randomized Controlled Trial

Abstract

Abstract PURPOSE Distal rectal transection following robotic total mesorectal excision (TME) for rectal cancer can be challenging especially in the deep and narrow pelvis. This can be performed transabdominally using either a robotic stapler (RS) or laparoscopic stapler (LS). We compared the operative outcomes and ergonomic differences between RS and LS after robotic TME. METHODS We performed a single center randomized controlled trial. 40 patients with rectal or rectosigmoid cancer who were planned for elective robotic rectal surgery were randomized to either RS (N = 20) or LS (n = 20). Primary outcome was the number of stapler cartridges required to completely transect the rectum. Secondary end points included technical ease and efficacy of stapler use, completeness of the staple line, staple line bleeds, and clinically significant anastomotic leaks. RESULTS The mean number of stapler cartridges expended was similar between RS and LS (1.75 versus 2.05, p =0.082). While significantly less stapler adjustments were required in the RS group (1.55 versus 2.75, p = 0.014), complete rectal transection took a comparable amount of time ( p =0.149). There were no differences in integrity of staple line, staple line bleeding and anastomotic leaks. Results from the user experience survey showed that RS scored better for control, engagement, visualization and overall experience. Experience with firing and disengagement was similar between both groups. CONCLUSION The RS was more ergonomic than the LS. While this complemented the use of robotics in rectal surgery, it did not result in a significant reduction in the number of stapler cartridges required for rectal transection.