Totally Robotic Low Anterior Resection and Left Colectomy with Systematic Splenic Flexure Mobilization a Single Docking Procedure for Sigmoid and Rectal Cancer: Technical Notes and Results - Abstract
Surgery with robotic systems is known to have several advantages despite laparoscopy, even in colorectal cancer. However, there is no standard procedure to maximize the advantages of the DaVinci® Si Surgical System. The authors describe their personal single stage totally robotic technique, applying the robotic system during all of the dissection steps in left colon and rectal cancer surgery with a single docking. From March 2012 to March 2016, 83 consecutive patients affected by left colon or rectal cancer were selected for robotic-assisted colorectal resection with DaVinci® Si Robotic System (Intuitive Surgical Inc., Sunnyvale, CA); clinical and pathological outcomes were prospectively collected and reviewed. All patient underwent left colectomy (LC) or low anterior resection (R-LAR) with a single stage, totally robotic dissection, performed following these steps from the top downwards in a clockwise direction to avoid arm collision, splenic flexure mobilization, legation of inferior mesenteric vessels and medial to lateral colon dissection, mobilization of descending and sigmoid colon, TME and rectal dissection, rectal transection and anastomosis. We treated 83 consecutive patients of which 41 (49%) were men and 42 (51%) were women, mean age was 70 (range, 42–92) years. All patients suffered from sigmoid (41pts) an rectal (42 pts) cancer. Clinical and oncologic outcomes, short term complications were analyzed: the circumferential margin, for rectal cancer, was positive in one patient, 17.9 (range, 6–48) lymph nodes were harvested, tumor’s distance from distal margin’s resection was 2.4 cm (range 1-9). The length of hospital stay after surgery was 6 (range, 4–33) days. Anastomotic leak rate was 1.2% and were managed by ileostomy. There were 4 major complications (4.8%); no mortality occurred. The global conversion rate to laparoscopic and/or open procedure for surgical reasons was 0%. The mean total operative time was 215 minutes, while the mean robotic time was 130 minutes. Single docking for left colon and rectal surgery can be a suitable procedure to reduce operative time and to maximize the advantages of robotic approach. More studies are needed to standardize the surgical procedure.