Impact of the new robotic platform hinotori™ in preventing subcutaneous emphysema after colorectal cancer surgery

Background: In the field of abdominal surgery, including colorectal cancer surgery, robotic surgery has become widespread, and the introduction of new robotic platforms is increasing. As a result, the incidence of subcutaneous emphysema (SE) as a postoperative complication has increased; however, the causes, grade, and perioperative course of SE have not been definitively examined. Therefore, we aimed to evaluate potential risk factors of SE after robotic colorectal cancer surgery.

Methods: Between November 2022 and March 2024, 244 consecutive patients who underwent robotic colorectal cancer surgery using the da Vinci Xi (n = 190) or the hinotori™ platform (n = 54) were retrospectively analyzed. Risk factors associated with postoperative SE were assessed by multivariate analysis using logistic regression models. Moreover, the grade of SE and its perioperative course were investigated based on the two robotic platforms.

Results: Postoperative SE was observed in 95 patients (38.9%). Nine patients (3.7%) had severe SE. The risk factors for SE were female sex, older age (≥ 80 years), and maximum intraabdominal pressure (max IAP) with CO₂ insufflation > 10 mmHg (odds ratio [95% confidence interval]: 1.981 [1.105-3.552], p = 0.022; 2.765 [1.310-5.835], p = 0.008; and 13.249 [1.227-143.020], p = 0.033, respectively). Additionally, the incidence of SE when using the hinotori™ platform was significantly lower than when using the da Vinci Xi platform (0.302 [0.135-0.667], p = 0.004).

Conclusions: Max IAP with CO₂ > 10 mmHg was associated with SE during robotic colorectal cancer surgery. Compared with the use of da Vinci Xi, the use of hinotori™ was associated with fewer incidences of postoperative SE, especially in females and older patients (≥ 80 years).