Improved operative efficiency with the da Vinci Xi: a comparative study of robotics and laparoscopic ventral mesh rectopexy.

Abstract

Laparoscopic ventral rectopexy (LVR) is a widely used technique in the treatment of rectal prolapse but faces limitations due to restricted working space within the narrow confines of the pelvic cavity and suboptimal ergonomics. The advent of robotic platforms, particularly the da Vinci Xi system, has offered solutions by enhancing visualization and precision. This study retrospectively compares outcomes between LVR and robotic ventral rectopexy (RVR), and between the da Vinci Si and Xi robotic systems. This retrospective cohort study analyzed 315 a consecutive series of patients who underwent minimally invasive ventral mesh rectopexy between March 2019 and October 2024 by a single operator at a single institution. Patients were divided into laparoscopic (n = 72) and robotic (n = 243) groups, with the robotic cohort further categorized into Si (n = 159) and Xi (n = 84) subgroups. The outcomes measures included operative time, console time, hospital stay and perioperative complications. The robotic group demonstrated a shorter median length of stay (1vs.2 days, p < 0.01) with similar operative times. Prior hysterectomy was associated with increased operative time, while age and redo surgery were not. The Xi platform significantly reduced operative and console times compared to the Si (80vs.100 min, p < 0.01; 55vs.68 min, p < 0.01). This is the first study to demonstrate that the robotic-assisted technique has shorter operative times as compared to laparoscopic technique. Among robotic platforms, the da Vinci Xi system further enhances these benefits, surpassing the Si platform in efficiency. These findings establish robotic rectopexy, particularly with the Xi system, as the preferred method for optimizing surgical outcomes in the surgical treatment of rectal prolapse syndromes.