Da Vinci Xi: a better platform for robotic-assisted radical prostatectomy?

Abstract Background An upgraded surgical robot platform, da Vinci Xi, had demonstrated multiple advantages over the previous da Vinci Si system. Better surgical outcomes had been reported in various operations except for robotic-assisted radical prostatectomy (RARP). We sought to compare and analyze the outcomes of RARP between using the da Vinci Xi and the da Vinci Si. The learning curve of docking with the new surgical robot and method for RARP was also evaluated. Methods An initial series of 77 RARPs have since been performed with the side docking technique since the installation of the da Vinci Xi. Another series of 96 consecutive RARPs were performed immediately before the uptake using the da Vinci Si and central docking technique. We compared the clinicopathological, perioperative, and postoperative outcomes of these two groups. We also analyzed the learning curve of the transition from central docking with the da Vinci Si to side docking with the da Vinci Xi. Results The Xi group had a shorter console time (208.2 vs. 285.7 min, p=0.004), less estimated blood loss (193.5 vs. 259.9 mL, p=0.018), and faster docking time (5.12 vs. 7.95 min, p=0.002) than the Si group. There were no significant differences regarding perioperative and postoperative outcomes. The plateau of the learning curve of side docking with the da Vinci Xi system was reached after 27 cases, and led to a significantly shorter docking time than before completing the learning curve (3.72 vs. 7.70 min, p<0.001). Conclusion Performing RARP with the da Vinci Xi system and side docking improved intraoperative outcomes and the docking time was almost negligible after gaining sufficient experience with the new system and docking technique. However, the complication rate and postoperative outcomes did not significantly benefit from the da Vinci Xi model.