A new application of the four-arm standard da Vinci® surgical system: Totally robotic-assisted left-sided colon or rectal resection

Dean Chi Siong Koh, Charles Bih Shou Tsang, Seon Hahn Kim

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci® S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. Aim To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vibci® system with a fourth arm extension. Methods The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Results Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3%) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. Conclusions The standard da Vibci® system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with shortterm outcomes similar to those of conventional laparoscopic techniques.

Original languageEnglish
Pages (from-to)1945-1952
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume25
Issue number6
DOIs
Publication statusPublished - 2011 Jun 1

Fingerprint

Robotics
Colon
Arm
Rectal Neoplasms
Rectum
Transverse Colon
Operative Time
Pelvis
Surgical Instruments
Colonic Neoplasms
Ligation
Dissection
Hip
Length of Stay
Lymph Nodes
Morbidity
Mortality
Neoplasms

Keywords

  • Four arms
  • Laparoscopic
  • Rectal
  • Robotic
  • Standard da Vinci
  • Total

ASJC Scopus subject areas

  • Surgery

Cite this

A new application of the four-arm standard da Vinci® surgical system : Totally robotic-assisted left-sided colon or rectal resection. / Koh, Dean Chi Siong; Tsang, Charles Bih Shou; Kim, Seon Hahn.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 25, No. 6, 01.06.2011, p. 1945-1952.

Research output: Contribution to journalArticle

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abstract = "Background The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci{\circledR} S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. Aim To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vibci{\circledR} system with a fourth arm extension. Methods The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Results Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3{\%}) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. Conclusions The standard da Vibci{\circledR} system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with shortterm outcomes similar to those of conventional laparoscopic techniques.",
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