The new da Vinci Xi system represents the 4th generation of surgical robotic technology. It is currently the most advanced platform for robot-assisted minimally invasive surgery, approved for use in Russia. Almazov Centre installed this system at the end of last year and it became its third robotic system. The Centre has been performing robotic procedures for more than 12 years and has been delivering a training program for surgeons led by Prof. Mikhail Mosoyan, head of the Department of Urology with Robotic Surgery Course.
The new Da Vinci Xi system has already been used by surgeons of Almazov Centre to perform dozens of successful procedures for complex clinical cases, including those with severe comorbidities.
According to the robotic surgeons of Almazov Centre, the new surgical system has some undeniable advantages. It features upgraded manipulators or robotic arms with better movement, reach and dexterity. The redesigned arms of the Xi system are mounted to an overhead boom offering more flexibility. Thanks to this more mobile and ergonomic design, the new robot can perform a wider range of procedures and even several interventions on different anatomical zones without remounting the entire system and changing the access and position of the robot.
Unlike Da Vinci Si, the patient console of the new system has a special touchscreen that is used to set the necessary parameters for a particular procedure, including the anatomical region and the patient side, thereby the system determines the optimal position for docking. For a simplified and optimized docking procedure, the patient console uses a system of laser sensors that recognize the safe distance from foreign objects and elements of the robotic system.
The previous version of Da Vinci included a special trocar of a certain size allowing for the insertion of endoscopic camera, and one of the four robotic arms was adapted for this. The new model has a lighter and thinner endoscope, allowing it to be placed in any of the robotic trocars. Like the previous model, the new Da Vinci Xi robot has 4 arms, but the camera can be placed in any of them as they are identical and the ports are also the same size. Also, in the Da Vinci Xi system, the surgeon can change the viewing angle of the camera, while not changing the position of the endoscope (in previous models it was necessary to manually change the camera position with the help of assistants).
During robotic procedures, the surgeon operates seated at the console and relies on the assistants in the operating room. For them, the preparation for the procedure and work on the new system are also unified and automated as much as possible.
“Now it doesn't matter where you want to place the instrument or the endoscope. Each of the manipulators of the patient console can be used as an endoscope manipulator. It does not need to be covered with a drape as it can be sterilized along with other instruments,” explains Dmitry Fedorov, urologist, assistant surgeon of the Da Vinci robotic system.
The unique experience of doctors at Almazov Centre in the field of robotic surgery, as well as its philosophy implying a personalized and team approach have become the key to successful collaboration of doctors from various specialties in the treatment of comorbid patients.
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That is why Almazov Centre often has a solution for many patients who cannot find a treatment elsewhere. Robotic surgeons work together with cardiologists, intensivists, oncologists, gynecologists, general surgeons, vascular surgeons and other doctors. This multidisciplinary approach allows them to perform truly unique surgical procedures, for example, on the prostate, kidneys, intestines and other organs. At the same time, doctors are constantly developing and implementing new, most effective and optimal methods of surgical treatment.
One example of such a successful collaboration was the recently performed robot-assisted nephrectomy in a patient with a giant aneurysm in the renal hilum. A 44-year-old patient with this rare and dangerous renal vascular anomaly was admitted to the vascular surgery clinic of Almazov Centre headed by Dr. Mikhail Chernyavsky.
“The danger is that this disease is most often asymptomatic, but if an aneurysm ruptures, this will inevitably lead to severe bleeding and, most likely, death,” comments Dr. Artemiy Chernov, head of Department No. 2.
A team of urologists and cardiovascular surgeons at Almazov Centre has already jointly performed a number of surgical procedures. Nephrectomy (removal of the kidney) is not the rarest procedure, however, taking into account the size of the aneurysm and the location of the renal vessels in this patient, such surgical treatment was extremely dangerous and difficult. The well-coordinated work of the most experienced robotic and vascular surgeons, coupled with the capabilities of robotic surgery, made it possible to perform the toughest procedure without complications and blood loss. Professor Mosoyan operated the robot and vascular surgeons with Dr. Chernyavsky, head of the Research Institute of Vascular and Interventional Surgery, were present in the operating room. The very next day after the procedure the woman was able to move around the ward and was discharged for outpatient treatment a few days later in a satisfactory condition.
Also, thanks to the capabilities of the new Da Vinci Xi system, Almazov Centre has successfully started robotic colorectal surgery. It should be noted that, along with urological and gynecological procedures, robot-assisted general surgery procedures in cancer patients are among the three most frequently performed worldwide. Every year, the number of performed surgeries with good oncological and non-oncological outcomes increases.
Recently, a 59-year-old patient was hospitalized at the department of surgical methods for cancer treatment headed by Dr. Dmitry Nasedkin for middle ampullary cancer. Taking into account the recurrent episodes of massive intestinal bleeding, the oncology team decided on surgical management as the first stage of treatment.
The patient was successfully operated on using the Da Vinci surgical robot. A thorough preoperative planning, surgical tactics, patient preparation and postoperative management were the result of the collaboration of specialists from the Department of Surgical Methods for Cancer Treatment headed by Dr. Ivan Danilov and a team of Robotic Surgery Centre headed by Prof. Mikhail Mosoyan. The surgery was performed jointly by Dr. I. Danilov and Prof. M. Mosoyan, assisted by doctors from the Robotic Surgery Centre. A part of the colon with a tumor with a margin of heathy tissues was removed using the Da Vinci Firefly fluorescence imaging technology designed to provide real-time endoscopic imaging in the visible and near-infrared fluorescence range. The ends of the healthy intestine were then sewed together by the robotic arms.
“The large tumor was inconveniently located in the distal rectum, this location presenting objective difficulties for the formation of an anastomosis to connect the ends of the resected organ. It is usually done laparoscopically with a special stapler. In this case, all stages were performed on a robotic system,” explains DR. Ivan Danilov.
The patient tolerated the surgery well, the postoperative period was smooth and uneventful, and he was discharged in a satisfactory condition the week after the surgery.
The above cases show how the undeniable experience of surgeons coupled with the latest technologies made it possible to perform an extremely complex surgery in very narrow anatomical spaces in the human body without compromising the quality and time.