Is the Bipolar Vessel Sealer Device an Effective Tool in Robotic Surgery? A Retrospective Analysis of Our Experience and a Meta-Analysis of the Literature about Different Robotic Procedures by Investigating Operative Data and Post-Operative Course

Background: The latest robotic bipolar vessel sealing tools have been described to be effective allowing to perform procedures with reduced blood loss and shorter operative times. The aim of this study was to assess the efficacy and reliability of these devices applied in different robotic procedures. Material and methods: All robotic operations, between 2014 and 2016, were performed using the EndoWrist One VesselSealer (EWO, Intuitive Surgical, Sunnyvale, CA), a bipolar fully wristed device. Data, including age, gender, body mass index (BMI), were collected. Robot docking time, intraoperative blood loss, robot malfunctioning and overall operative time were analyzed. A meta-analysis of the literature was carried out to point the attention to three different parameters (mean blood loss, operating time and hospital stay) trying to identify how different coagulation devices may affect them. Results: In 73 robotic procedures, the mean operative time was 118.2 minutes (75-125 minutes). Mean hospital stay was four days (2-10 days). There were two post-operative complications (2.74%). Conclusions: The bipolar vessel sealer offers the efficacy of bipolar diathermy and the advantages of a fully wristed instrument. It does not require any change of instruments for coagulation or involvement of the bedside assistant surgeon. These characteristics lead to a reduction in operative time.