Comparative perioperative and oncological outcomes of the da Vinci Xi versus Si robotic surgical systems in rectal cancer surgery: a systematic review and meta-analysis.
Ivens Murad Garcia Magalhães, Fillipe Augusto de Oliveira Paixão, Gustavo Tamura et al.
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In 30 seconds
This systematic review and meta-analysis compared perioperative and oncological outcomes with da Vinci Xi versus Si systems in rectal cancer surgery. It included eight non-randomised cohorts comprising 843 patients (380 Xi, 463 Si). Across five cohorts reporting operative time, the pooled mean difference was - 27.7 min (95% confidence interval - 80.4 to + 25.0; I² 95%), with substantial heterogeneity. The authors judged evidence on platform effects very uncertain, with very low certainty across assessed outcomes; functional outcomes were not compared.
Key findings
- Across five cohorts, operative time differed by - 27.7 min (95% confidence interval - 80.4 to + 25.0; I² 95%).
- Anastomotic leak evidence was very uncertain: risk ratio 0.53, 0.24 to 1.14.
- Docking time was shorter with Xi in all three reporting cohorts, although definitions varied or were absent.
- Functional outcomes were not compared.
Why it matters
The review addresses whether the Xi system’s design translates into better rectal cancer surgery outcomes than the Si. Its findings do not establish a reliable advantage in operative or oncological outcomes, and the high heterogeneity in operative-time estimates underscores the difficulty of interpreting comparisons across different settings and experience levels.
What to keep in mind
All eight included studies were non-randomised cohorts. Comparisons spanned different periods, centres and levels of experience, so the analysis could not isolate the effect of the platform; certainty was very low throughout.