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.
4 affiliations
- 1Faculdade de Medicina, Universidade Federal de Juiz de Fora, Avenida Presidente Itamar Franco, Juiz de Fora, Minas Gerais, Brazil.
- 2Hospital Governador Celso Ramos, Florianópolis, Santa Catarina, Brazil.
- 3Hospital Sírio-Libanês, São Paulo, Brazil. [email protected].
- 4Discipline of Surgical Technique and Experimental Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. [email protected].
Abstract
The da Vinci Xi replaced the Si with a boom-mounted architecture intended to remove the re-docking and multiquadrant limits on pelvic access. Whether it changes outcomes in rectal cancer surgery is unresolved: existing syntheses pooled rectal with colonic resection. Five databases, Google Scholar and citation graphs were searched to August 2026, without language or design restriction, for comparative studies reporting outcomes separately by platform in rectal cancer resection. Screening, extraction and risk-of-bias assessment were done in duplicate. Random-effects models with a Hartung-Knapp adjustment were used; certainty was rated with GRADE. Eight non-randomised cohorts (843 patients; 380 Xi, 463 Si) were included. Pooling all five cohorts reporting operative time, the mean difference was - 27.7 min (95% confidence interval - 80.4 to + 25.0; I² 95%); restricted to the four reporting means with standard deviations, thus conditional on excluding the largest cohort, it was - 50.6 min (- 69.4 to - 31.7). Docking time was shorter with the Xi in all three reporting cohorts, which defined it differently or not at all. The evidence is very uncertain about the effect of platform on anastomotic leak (risk ratio 0.53, 0.24 to 1.14), complications, conversion, reoperation, margin involvement and specimen quality; certainty was very low throughout. The evidence is very uncertain about the effect of the da Vinci Xi compared with the Si on perioperative and oncological outcomes in rectal cancer, and functional outcomes have not been compared. Because the platforms were compared across periods, centres and levels of experience, no estimate isolates the platform.PROSPERO registration CRD420261480007, registered 18 August 2026, before data extraction.
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BibTeX
@article{magalhaes2026comparative,
title = {{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.}},
author = {Ivens Murad Garcia Magalhães and Fillipe Augusto de Oliveira Paixão and Gustavo Tamura and Pedro Averbach},
journal = {Journal of robotic surgery},
year = {2026},
month = oct,
doi = {10.1007/s11701-026-04059-0},
url = {https://europepmc.org/article/MED/42900273},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Ivens Murad Garcia Magalhães
AU - Fillipe Augusto de Oliveira Paixão
AU - Gustavo Tamura
AU - Pedro Averbach
PY - 2026
DA - 2026/10/20
JO - Journal of robotic surgery
DO - 10.1007/s11701-026-04059-0
UR - https://europepmc.org/article/MED/42900273
AB - The da Vinci Xi replaced the Si with a boom-mounted architecture intended to remove the re-docking and multiquadrant limits on pelvic access. Whether it changes outcomes in rectal cancer surgery is unresolved: existing syntheses pooled rectal with colonic resection. Five databases, Google Scholar and citation graphs were searched to August 2026, without language or design restriction, for comparative studies reporting outcomes separately by platform in rectal cancer resection. Screening, extraction and risk-of-bias assessment were done in duplicate. Random-effects models with a Hartung-Knapp adjustment were used; certainty was rated with GRADE. Eight non-randomised cohorts (843 patients; 380 Xi, 463 Si) were included. Pooling all five cohorts reporting operative time, the mean difference was - 27.7 min (95% confidence interval - 80.4 to + 25.0; I² 95%); restricted to the four reporting means with standard deviations, thus conditional on excluding the largest cohort, it was - 50.6 min (- 69.4 to - 31.7). Docking time was shorter with the Xi in all three reporting cohorts, which defined it differently or not at all. The evidence is very uncertain about the effect of platform on anastomotic leak (risk ratio 0.53, 0.24 to 1.14), complications, conversion, reoperation, margin involvement and specimen quality; certainty was very low throughout. The evidence is very uncertain about the effect of the da Vinci Xi compared with the Si on perioperative and oncological outcomes in rectal cancer, and functional outcomes have not been compared. Because the platforms were compared across periods, centres and levels of experience, no estimate isolates the platform.PROSPERO registration CRD420261480007, registered 18 August 2026, before data extraction.
SN - 1863-2483
SN - 1863-2491
ER -