DOI: 10.1097/DCR.0000000000000713

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PMID: 28267014

Issn Print: 0012-3706

Publication Date: 2017/04/01


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Robotic Complete Mesocolic Excision and Intracorporeal Anastomosis Using a Robotic Stapler for Right-Sided Colon Cancer With Reduced-Port Access

Sung Uk Bae; Woon Kyung Jeong; Seong Kyu Baek

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Excerpt

Along the lines of total mesorectal excision for rectal cancer,1 complete mesocolic excision for colon cancer has been introduced, and it is increasingly adopted by minimally invasive surgeons as the optimal approach for colon cancer resection.2–4 This surgical concept achieves complete removal of tumor-bearing lymphoadipose tissues enveloped by the mesocolic fascia and radical lymphadenectomy at the origin of feeding vessels.
The robotic single-port access platform was specifically developed to overcome the limitations of single-port laparoscopic surgery. This platform, designed for single-port surgery, can easily create instrument triangulation and minimizes collisions between robotic arms because, although the robotic arms are crossed at the remote center, they are reassigned by the software to match the corresponding hand of the surgeon on the robotic console. Thus, each of the surgeon’s hands corresponds with the robotic arm in the ipsilateral surgical view. However, this platform has not been widely applied to colorectal diseases because of the limited variety of available instruments, the lack of wrist articulation allowing 7° of freedom to move, the limited range of motion of the semirigid robotic instruments, and the lack of second traction that is required for colorectal surgery.
The robotic single-port access plus 1 wristed robotic arm for colon cancer was introduced in 2014.5 In right-sided colon cancer, this technique enables precise lymph node dissection around the superior mesenteric trunk, using the wristed robotic instruments; this approach maintains the cosmetic advantage of single-port laparoscopic surgery and allows safe intracorporeal side-to-side anastomosis using the wristed robotic stapler via an 8-mm conventional robotic port. Here, we report the first case of complete mesocolic excision and intracorporeal anastomosis by using robotic single-port access for right-sided colon cancer. This approach may be a viable option until a more advanced robotic platform that is specifically designed for single-port surgery is developed. See Video at http://links.lww.com/DCR/A261.

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