Gastrointestinal diseases can strike anyone at any age. A wide variety of conditions can affect the gastrointestinal tract, starting from esophagus, stomach, liver, gallbladder, small intestine, large intestine to rectum. Gastrointestinal diseases can be induced by different factors, e.g. viral or bacterial infections, inflammation, acid reflux and unhealthy habits, e.g. alcohol consumption. Disease severity varies, ranging from mild to life-threatening conditions which often include esophageal cancer, colorectal cancer and stomach cancer. For certain types of gastrointestinal cancer, surgery remains the treatment of choice, particularly if caught in early stages. Medical advancements in surgery have continued to expedite the pace of changes, allowing better treatment outcomes for patients who require gastrointestinal surgery. Cutting-edge robotic system, the da Vinci Xi is designed to accommodate and seamlessly integrate a range of current technologies in surgical areas, including intraoperative imaging, advanced instruments and anatomical access, enabling the surgeons to perform minimally invasive procedures in hard-to-reach surgical sites through small incisions. Indeed, the use of the da Vinci Xi is associated with reduced risks of postoperative complications, less pain and a shorter operative time. 

Advances in gastrointestinal surgery

Surgery plays a crucial role in treating patients diagnosed with gastrointestinal cancer. Not only to help confine the disease and minimize the chance of spreading to adjacent or distant organs, but surgery conducted in a timely manner also enables the patients to regain their quality of life. To treat esophageal, colorectal and stomach cancers, surgery usually involves two steps: cancer resection followed by reconstruction in order to allow the digestive tract to function as much as viable. In the past, due to the complexity of digestive system, conventional surgery might pose major disadvantages as it requires a large incision with longer operative time to reach the affected area. To overcome these limitations, a minimally invasive surgery through smaller incisions has emerged with superior benefits of less pain and faster recovery. The da Vinci system is an advanced technology designed to enable surgeons to perform robotic-assisted, minimally invasive gastrointestinal surgery, particularly in anatomically challenging areas. As a result of greater surgical precision, it leads to reduced risks of postoperative complications, shorter operative time and quick return to daily life and activity.

What is the da Vinci Xi?

The da Vinci Xi is an advanced robotic surgical system using specialized technology which enhances the surgeon’s capabilities and expertise. Controlled by a computer system, four robotic arms consisting of tiny instruments with wrists at the tip allow surgeons to perform procedures in complex areas such as gastrointestinal tract with precise movements, better dexterity and enhanced magnification. These robotic arms are, in fact, capable of free movements of nearly 360° on seven axes, thereby improving access to anatomically challenging or hard-to-reach positions. Special high-definition camera attached provides magnified 3D views of the operating area, leading to high degree of surgical accuracy and patient’s safety. For every movement, the surgeon makes at the console standing next to the surgical arms. The da Vinci robot replicates every move inside patient’s body on a smaller scale. The surgeon has complete control during the entire procedure. 

What are abdominal conditions that can be treated with the da Vinci Xi? 

The da Vinci Xi has been widely applied to the surgical treatment of gastrointestinal cancers, such as: 

• Esophageal cancer: Esophageal cancer is cancer arising from the esophagus that runs between the throat and the stomach. Treatment for esophageal cancer depends on the stage and severity of disease. When it is found in an early stage, surgery is one of the main modalities yielding a better chance of cure. Esophageal cancer surgery involves the removal of the tumor, part of the esophagus and tissue around the tumor as well as lymph nodes where cancer cells may have spread. After cancer surgery, the surgeon needs to reconstruct the esophagus by replacing some of it with a section of stomach or colon, depending on the required graft. Both cancer resection and reconstruction for esophageal cancer treatment is technically complex in which extensive expertise of the surgeon is required due to the anatomical challenges of the esophagus that is connected with other vital organs. To promote surgical precision while reaching the esophageal area, robotic-assisted surgery using the da Vinci Xi allows the surgeon to access anatomically challenging sites, increasing the chance of successful treatment while preserving surrounding areas.     
• Colorectal cancer: Surgery is often the main treatment option for early-stage colon cancer when the disease has not spread to other organs in the body. The type of surgery used depends on the stage of the cancer and its location. Surgery aims to remove all or some part of the colon or rectum containing cancer cells. Nearby lymph nodes are also removed and the remaining sections of colon are then reattached, enabling the patients to defecate properly after surgery. Apart from the conventional or open surgery in which a large incision is required, laparoscopic colorectal surgery is done through smaller incisions. During the procedure, a laparoscope, a long, thin lighted tube with a small camera and light on the end is inserted through small incision, enabling the surgeon to clearly see inside the abdomen. Other surgical instruments are then placed through other incisions to remove part of the colon and lymph nodes. Compared to open technique, laparoscopic colorectal surgery provides greater precision, minimizing the chance of injuries to the surrounding tissues and organs. Due to smaller incisions, it can result in less pain and shorter hospital stay, allowing for a rapid recovery. Robotic-assisted colorectal surgery using the da Vinci Xi plays an important role in aiding the surgeon to operate in complex or hard-to-reach area while reducing operative time and complications, leading to successful outcome.       
• Stomach cancer: Treatment of stomach or gastric cancer depends greatly on cancer location and its stage, how far it has spread. Other factors, such as a patient’s age, overall health and preferences are important as well. Stomach cancer in early stage in which cancer cells have not grown deeply into the wall of the stomach or spread outside the stomach can typically be treated by surgery, called gastrectomy. The surgery is to remove some part of the stomach containing cancer cells followed by jejunal reconstruction where the remaining part of stomach is reconnected to jejunum – the most extensive part of the small intestine. Reconstruction helps digestive function and maintains satisfactory nutritional status. Since robotic arms bend and freely rotates to reach structure with high degree of complexity, robotic-assisted gastrectomy surgery may improve postoperative outcomes in comparison to open surgery. These often include less pain and faster recovery time with a rapid return to daily life and activity. 

What are advantages of the da Vinci Xi for minimally invasive gastrointestinal surgery? 

The fourth generation of the da Vinci system yields benefits, including: 

• Improved visualization: A sophisticated camera provides magnified, high-definition views of the surgical area with a better visualization of vessels, nerves and muscles nearby, resulting in less complications caused by damages to the surrounding areas. 
• Less pain after surgery: Since robotic-assisted surgery only requires small incisions, it results in less pain caused by the surgical wound with less swelling and inflammation. 
• Reduced complications with faster recovery: Due to small incisions, patients often experience faster recuperation while resuming their diet sooner with a quick return to daily life.