Ann Surg Treat Res.  2016 Oct;91(4):212-217. 10.4174/astr.2016.91.4.212.

Single-port plus an additional port robotic complete mesocolic excision and intracorporeal anastomosis using a robotic stapler for right-sided colon cancer

• Bae SU
• Jeong WK
• Baek SK

• KMID: 2354330
• DOI: http://doi.org/10.4174/astr.2016.91.4.212

Abstract

The concept of complete mesocolic excision and central vascular ligation for colonic cancer has been recently introduced. The paper describes a technique of right-sided complete mesocolic excision and intracorporeal anastomosis by using a single-port robotic approach with an additional conventional robotic port. We performed a single-port plus an additional port robotic surgery using the Da Vinci Single-Site platform via the Pfannenstiel incision and the wristed robotic instruments via an additional robotic port in the left lower quadrant. The total operative and docking times were 280 and 25 minutes, respectively. The total number of lymph nodes harvested was 36 and the proximal and distal resection margins were 31 and 50 cm, respectively. Single-port plus an additional port robotic surgery for right-sided complete mesocolic excision and intracorporeal anastomosis appears to be feasible and safe. This system can overcome certain limitations of the previous robotic systems and conventional single-port laparoscopic surgery.

Keyword

Colonic neoplasms; Robotic surgical procedures; Laparoscopy; Mesocolon; Lymph node excision

MeSH Terms

Colon*
Colonic Neoplasms*
Laparoscopy
Ligation
Lymph Node Excision
Lymph Nodes
Mesocolon
Robotic Surgical Procedures
Wrist

Figure

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  Fig. 1 (A) Colonoscopy reveals a 2-cm-sized ulcerofungating mass in the cecum, and (B) fluorodeoxyglucose scan reveals the hypermetabolic nature of the lesion.

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  Fig. 2 Robotic cart placement and docking of the robotic ports. SUL, spino-umbilical line; MCL, midclavicular line.

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  Fig. 3 Adjustment of remote centers to secure the surgical space; (A) remote centers of R1, R2 cannulas and camera port are lifted upward out of the abdominal wall, and (B) all 3 remote centers are aligned at the same level.

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  Fig. 4 Access port setup for single-port plus an additional port robotic surgery for right-sided colon cancer.

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  Fig. 5 Single-port plus an additional port robotic complete mesocolic excision with intracorporeal anastomosis, (A) Control of the ileocolic vessels, (B) colonic, pancreatic, and gastric branches draining to the gastrocolic trunk, (C) dissection around middle colic artery, (D) omental detachment for hepatic flexure mobilization using, (E) side-to-side intracorporeal isoperistaltic anastomosis with robotic stapler, and (F) closure of the stapler insertion site with robotic-assisted continuous stitches. ICA, ileocolic artery; ICV, ileocolic vein; SMV, superior mesenteric vein; RGEV, right gastroepiploic vein; RCV, right colic vein; ASPDV, anterior superior pancreaticoduodenal vein; GCT, gastrocolic trunk, MCA, middle colic artery

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  Fig. 6 The postoperative patient view. The additional port site is used for drain placement.

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