Comparison of perioperative outcomes and oncological efficacy between Da Vinci Si and Da Vinci Xi robotic systems in colorectal surgery: systematic review and meta-analysis of controlled trials

Abstract

This systematic review and meta-analysis investigated the effectiveness of the two models of surgical robotics in performing colorectal surgery based on the difference in perioperative outcomes of the Da Vinci Si robotic system, the Da Vinci Xi robotic system, and the control group derived from a meta-analysis of controlled trials. The electronic databases of PubMed, EMBASE, Google Scholar, and the Web of Science were searched widely in order to identify a total number of randomized controlled trials (RCTs) as well as cohort studies on colorectal cancer procedures using the Da Vinci Si and Xi systems. Random effect analysis for data was done using Review Manager 5.4. The metric data were analyzed according to the weighted mean difference (WMD) and nominal or ordinal data were analyzed according to odds ratios (OR) and 95% confidence intervals (CI). This meta-analysis incorporated data from eight comparative studies involving 1,000 patients undergoing robotic colorectal surgery, with 468 cases utilizing the Da Vinci Xi system and 532 cases using the Da Vinci Si system. Comparative analysis revealed statistically significant advantages for the Xi platform in three key perioperative parameters: operative time demonstrated a weighted mean difference (WMD) of -26.89 min (95% CI -53.43 to -0.36; P = 0.047), docking time showed a WMD of -4.18 min (95% CI -6.23 to -2.12; P < 0.001), and hospitalization duration was reduced by 0.98 days (95% CI -1.92 to -0.03; P = 0.043). Notably, the two systems exhibited comparable performance metrics with no statistically significant differences in several critical outcomes: intraoperative blood loss (P = 0.32), transfusion rates (P = 0.45), conversion rates (P = 0.78), overall postoperative complications (P = 0.61), and console operation time (P = 0.15). The analysis found no evidence of inherent technical superiority between the platforms when considering the comprehensive spectrum of surgical outcomes. The Da Vinci Xi system is safe to use and enhances operating room efficiency compared to the Da Vinci Si, while providing comparable safety and oncological outcomes. In light of these findings, future large-scale studies are warranted to further evaluate the clinical outcomes and cost-effectiveness of these robotic platforms in colorectal cancer surgery.

Keywords: Colorectal surgery; Da Vinci Si; Da Vinci Xi; Robotic surgery.