Multiquadrant and Multiorgan Robotic Surgery with the da Vinci Xi

Thanks to advances in diagnostics and imaging, the detection of multiple malignancies is becoming increasingly common in clinical practice. Combined multiquadrant surgery can be considered a viable strategy to avoid sequential surgeries linked to higher discomfort for patients, delayed initiation of adjuvant treatments, and poorer cosmetic outcomes. Although laparoscopy is a widespread minimally invasive surgical option allowing surgeons to quickly range over a wide operative filed, its kinematics limitations make some procedures very challenging. Robotic surgery was developed to overcome some drawbacks of laparoscopy such as limited dexterity and ergonomics. While procedures confined in a single surgical field such as the pelvis or supramesocolic area have been well documented with good results, moving between different abdominal quadrants can be very difficult with the first widespread version of the da Vinci robot, the da Vinci Si, due to its bulky cart. The advent of da Vinci Xi platform in 2015 brought further technical advantages in terms of flexibility and maneuverability, thanks to a boom-mounted system, camera-hopping and targeting function, making it possible to perform a multiquadrant surgery with a full robotic approach. Moreover, the availability of the da Vinci Table Motion can further improve the surgical workflow during multiquadrant and multiorgan challenging procedures.