Robotic Platform da Vinci Xi Is Feasible and Beneficial in Both Colon and Rectal Surgery in Short-Term Outcome and Recovery

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper presents a large case history of abdominal surgery, and colorectal surgery in particular. The article turns out to be well-written. The question concerns the choice of approach to be used. The authors say that RAL vs. LSC was chosen according to instrument availability and surgeons' preference, with no specific selection criteria. This may represent a selection bias. Also, it would be helpful to know how many surgeons performed the interventions and whether there is homogeneity of the learning curve among the surgeons. In part, this information is described by the authors in the "Limitations" section, but it appears to be a fairly determining factor.  

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Reviewer 2 Report

Comments and Suggestions for Authors

Critical comments on the manuscript.

1. please expand the paragraph limitations including the inclusion of limitations from the anaized studies

2. please shorten the conclusions and refer only to the data obtained during the analysis

Author Response

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Reviewer 3 Report

Comments and Suggestions for Authors

I congratulate the authors for their retrospective study, collecting 418 patients undergoing minimally invasive colorectal surgery, to investigate the safety and feasibility regarding da Vinci Xi system in colorectal surgery.

I think the technical content (Background, Materials and methods, Statistical analysis, Results, Discussion, Conclusions etc.) of the submitted manuscript might be satisfactory.

However, I think authors are encouraged to review several issues before publishing the article. Here are my comments;

1.      Postoperative complications were graded using the Clavien–Dindo classification. The authors should cite the paper regarding Clavien-Dindo classification.

2.      Body Mass Index (BMI) was collected and evaluated as one of the patients’ pre-operative characteristics. And they showed the sub-categories of BMI (underweight, normal, overweight, and obese) in the Table-1. Those sub-categories are designated by the WHO. The authors should mention that those subcategories are based on the WHO classification.

3.      Page 13, in the sub-section 5.3. Operation time: "the operation theater crew did not familiar with the instrument setup”. This sentence should be “the operation theater crew was not familiar with the instrument setup”.

4.      In the discussion section, the authors describe the da Vinci Xi system. The authors are encouraged to describe in more detail regarding the greater advantages of da Vinci Xi system over the previous one (Si system).

5.      In the study presented, robotic-assisted surgery showed better results when compared to laparoscopic surgery in overall complications, postoperative functional recovery and shorter length of stay in both the colectomy and rectum resection cohorts although the surgical time necessary for robotic-assisted surgery was longer than that required for laparoscopic surgery. The authors mention that they believe the better recovery from surgery in the robotic-assisted group may be benefiting from the more precise instrumental maneuvers performed during the robotic technique, which is less traumatic to the tissues during surgery. Could the authors cite any reference regarding the less traumatic instrumental maneuvers performed by robotic surgery? Or please describe more concrete examples of more precise techniques by robotic surgery.

Author Response

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Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

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Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this important manuscript. Here are my comments and suggestions.

 

Combine the following ‘’ The ma[1]jor indication for surgery was neoplasm, with other diseases such as diverticulitis, poly[1]poid tumor and lipoma also being included’’ with the inclusion criteria mentioned previously.

 

In the sentence ‘’ In those patients who received AbdominoPerineal Resection (APR), the specimen is retracted from the anus.’’ The authors should use only the abbreviation because the full term was already mentioned previously. Check for other abbreviations throughout the text.

 

The similar example is here ‘’For right-side colectomy, the same single docking method is used but in the left-side down Trendelenburg…’’ put ‘’For RH, the same single docking method…’’

 

Instead of ‘’ Secondary outcomes were post-operation functional outcomes.’’ put ‘’ Secondary outcomes were postoperative functional outcomes.’’

 

The potential bias is the age difference. For the rectum group, the difference is 10 years. In this situation, age could be an important factor for more complications and longer hospital length of stay. The same issue is with previous surgical history. So the authors have two important parameters that can increase postoperative complications (and conversion to open operation) and functional outcome, and both are in the laparoscopic group. Also, a significantly lower percentage had preoperative radiotherapy in the robotic group. And it is known that radiotherapy can increase local complication rate (anastomotic dehiscence or perineal fistula after APR) or functional outcome.

 

Also, there is no mention of these in the Limitations.

Comments on the Quality of English Language

It should be checked by a native English speaker.

Author Response

Thank you very much for taking the time to review this manuscript. We truly appreciate and thankful the precious feedback from you.

Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files

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Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Authors have done the corrections. I think that the work can be accepted.