Review of Robotic Simultaneous Resection of Colorectal Cancer with Synchronous Liver Metastases Using Da Vinci Xi: Technical Considerations and Outcomes.

Background: Robotic surgery has revolutionized the field of minimally invasive oncologic surgery. The Da Vinci Xi platform is a significant upgrade from older Da Vinci platforms facilitating multiquadrant and multi-visceral resection. We review the current technical factors and outcomes in robotic surgery for simultaneous resection of colon and synchronous liver metastases (CLRM) and provide future perspective on technical considerations for combined resection. Methods: A literature search on PubMed was performed and relevant studies from January 1st 2009 to January 20th 2023 were identified. Seventy-eight patients who underwent synchronous colorectal and CLRM robotic resection with the Da Vinci Xi were analysed and their indication, technical factors, and post-operative outcomes were studied. Results: The median operative time was 399 minutes and mean blood loss of 180 ml for synchronous resection. Post-operative complications were developed by 71.7% (43/78) patients, 41% being Clavien-Dindo Grade 1 or 2. There was no 30-day mortality reported. Technical factors including port placements and operative factors were presented and discussed for the various permutations of colonic and liver resections performed. Conclusion: Robotic surgery with the Da Vinci Xi platform is a safe and viable approach for simultaneous resection of colon cancer and CLRM. Future studies and sharing of technical experience will potentially facilitate standardization and increased uptake of robotic multi-visceral resection in metastatic liver only colorectal cancer.

Safety and Feasibility of Robotic-Assisted Drainage of Symptomatic Pancreatic Pseudocysts: A Case-Series Analysis (with video).

Background: The surgical treatment of pancreatic pseudocysts (PPs) in patients who fail nonoperative management has evolved from aggressive open to a minimally invasive approach. The application of robotic surgery in this setting is scarcely reported. The aim of this study is to analyze the safety and feasibility of the robotic approach to pancreatic pseudocyst drainage. Methods: A single centre retrospective review of consecutive patients undergoing robotic-assisted pancreatic pseudocyst surgeries in an academic tertiary institution was performed. Results: There were 14 patients studied, of whom 10 underwent cystogastrostomy and 4 Roux-En- Y cystojejunostomy. Eight patients had gallstone pancreatitis and 3 patients alcoholic pancreatitis. The mean size of cyst was 8.9 +-1cm and 57.1% located at the pancreatic body. The overall operative time of the procedure was 135 +-34 minutes. There were no open conversions. The overall success rate was 92.8%, while the primary success rate 85.7%. The major morbidity rate was 14.3% and there was no 30-day mortality. The mean post-operative hospital stay was 7 +-3 days with one recurrence of the pancreatic pseudocyst on follow-up requiring endoscopic drainage without further recurrence. Conclusions: The robotic approach for the drainage of symptomatic pancreatic pseudocyst is safe and feasible and can be considered as a viable modality for operative intervention in well-selected patients.