Articulation analysis of robotic staplers in rectal surgery.

PURPOSES: Robotic staplers offer several advantages in rectal surgery owing to their wide range of articulation and ergonomic manipulation. These benefits are evident during mobilization of the mesentery from the surrounding tissue and dissection of the rectum. However, no study has quantitatively evaluated the robotic stapler articulation in rectal surgery.

METHODS

We retrospectively enrolled 110 patients who underwent robotic anterior resection and double-stapling anastomosis. Stapling-related variables, including the type of cartridge, number of firings, time for initial stapling, and pitch/yaw of the stapling arm joint, were collated, and their association with patient background variables was analyzed.

RESULTS

The pitch ranged from - 56° to - 0.2° (median, - 36.3°), and the yaw ranged from - 57.9° to 54.2° (median, - 7.5°). A multivariate analysis showed that a more negative pitch value was independently associated with surgery for cT3/4 cancers (p = 0.042). Moreover, the pitch decreased as the distance from the anus to the staple line increased (p < 0.001). Female sex was the only factor independently associated with yaw (p = 0.029). Univariate analyses revealed that age ≥ 70 years, preoperative treatment, short cartridge selection, and multiple firings were correlated with a high anastomotic leakage rate.

CONCLUSIONS

This study clearly demonstrates how surgeons utilize the unique functions of robotic staplers during rectal transection.