Operative efficiency and short-term outcomes of da Vinci 5 versus da Vinci Xi in robotic rectal cancer surgery: an overlap-weighted cohort study with an exploratory case insights analysis
- 1Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, 350-1298 Japan
Abstract
The da Vinci 5 introduces changes in operative workflow and instrument control, but its comparative performance in rectal cancer surgery remains uncertain. We compared operative efficiency and short-term outcomes after platform introduction and explored platform-derived intraoperative measurements. This retrospective single-center study included 202 patients undergoing robot-assisted rectal cancer surgery from July 2025 to September 2026 (Xi, n = 109; da Vinci 5, n = 93). Propensity-score overlap weighting addressed measured differences. The primary outcome was total operative time. HC3 inference was checked using 2,000 bootstrap replicates with propensity-score re-estimation. Retrieved Case Insights records were summarized descriptively. The adjusted difference in total operative time was − 6.9 min (HC3 95% confidence interval [CI], − 24.4 to 10.6; P = 0.439); the bootstrap 95% CI was − 21.8 to 7.8 min. The adjusted risk difference for Clavien–Dindo grade ≥ II complications was − 9.4% points (HC3 95% CI, − 19.8 to 0.9; P = 0.074). Margin positivity occurred in only three patients and was reported descriptively. Inference for postoperative hospital stay depended on the variance method. We did not detect a statistically clear reduction in total operative time after the introduction of the da Vinci 5. Secondary outcomes remain exploratory. Exploratory Case Insights analysis provided descriptive information on instrument-tip force and surgical workflow, warranting further prospective validation of their clinical relevance.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04141-7.
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BibTeX
@article{ishiyama2026operative,
title = {{Operative efficiency and short-term outcomes of da Vinci 5 versus da Vinci Xi in robotic rectal cancer surgery: an overlap-weighted cohort study with an exploratory case insights analysis}},
author = {Yasuhiro Ishiyama and Yasumitsu Hirano and Yurie Kitano and Nozomi Yamazaki and Yoshihiro Sakai and Akihito Nakanishi and Yusuke Nishi and Hiroto Tanaka and Hisashi Hayashi and Toru Kuramoto and Takatsugu Fujii and Hirofumi Sugita and Chikashi Hiranuma},
journal = {Journal of Robotic Surgery},
year = {2026},
month = oct,
doi = {10.1007/s11701-026-04141-7},
url = {https://doi.org/10.1007/s11701-026-04141-7},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Operative efficiency and short-term outcomes of da Vinci 5 versus da Vinci Xi in robotic rectal cancer surgery: an overlap-weighted cohort study with an exploratory case insights analysis
AU - Yasuhiro Ishiyama
AU - Yasumitsu Hirano
AU - Yurie Kitano
AU - Nozomi Yamazaki
AU - Yoshihiro Sakai
AU - Akihito Nakanishi
AU - Yusuke Nishi
AU - Hiroto Tanaka
AU - Hisashi Hayashi
AU - Toru Kuramoto
AU - Takatsugu Fujii
AU - Hirofumi Sugita
AU - Chikashi Hiranuma
PY - 2026
DA - 2026/10/31
JO - Journal of Robotic Surgery
DO - 10.1007/s11701-026-04141-7
UR - https://doi.org/10.1007/s11701-026-04141-7
AB - The da Vinci 5 introduces changes in operative workflow and instrument control, but its comparative performance in rectal cancer surgery remains uncertain. We compared operative efficiency and short-term outcomes after platform introduction and explored platform-derived intraoperative measurements. This retrospective single-center study included 202 patients undergoing robot-assisted rectal cancer surgery from July 2025 to September 2026 (Xi, n = 109; da Vinci 5, n = 93). Propensity-score overlap weighting addressed measured differences. The primary outcome was total operative time. HC3 inference was checked using 2,000 bootstrap replicates with propensity-score re-estimation. Retrieved Case Insights records were summarized descriptively. The adjusted difference in total operative time was − 6.9 min (HC3 95% confidence interval [CI], − 24.4 to 10.6; P = 0.439); the bootstrap 95% CI was − 21.8 to 7.8 min. The adjusted risk difference for Clavien–Dindo grade ≥ II complications was − 9.4% points (HC3 95% CI, − 19.8 to 0.9; P = 0.074). Margin positivity occurred in only three patients and was reported descriptively. Inference for postoperative hospital stay depended on the variance method. We did not detect a statistically clear reduction in total operative time after the introduction of the da Vinci 5. Secondary outcomes remain exploratory. Exploratory Case Insights analysis provided descriptive information on instrument-tip force and surgical workflow, warranting further prospective validation of their clinical relevance. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04141-7.
SN - 1863-2483
SN - 1863-2491
ER -