Robotic Left Colon Cancer Resection: Dual Docking Technique for Splenic Flexure Mobilization

Se Jin Baek, Chang Woo Kim, Min Soo Cho, Hyun A Jang, Hyuk Hur, Seung Hyuk Baik, Nam Kyu Kim, Byung Soh Min, Sung Uk Bae. Yonsei University College of Medicine.

Background: The technique for robotic resection of the left colon is not well defined and has not been widely adopted due to limited range of motion of the robotic arms. We have developed dual docking technique for both the splenic flexure and the pelvis. We report our initial experience of robotic left colectomy using this technique for left-sided colon cancer.

Methods: The study group included 61 patients who underwent a robotic left colon cancer resection using dual docking technique between July 2008 and January 2013. The operations were divided into two stages: colon mobilization (stage 1) and rectal dissection (stage 2). After completion of stage 1, the da Vinci arms were undocked and the operating table was rotated 60 degrees counterclockwise and redocked.

Results: All 61 procedures were technically successful without the need for conversion to laparoscopic or open surgery. The median operation time was 227 min (range: 137-653) and estimated blood loss was 20 ml (20-2000). The median time to soft diet was 2 days (2-12) and length of stay was 7 days (4-20). The median total number of lymph nodes harvested was 17(3-61). According to the Clavien–Dindo classification, the numbers of complications forgrade1, 2, 3a, 3b, and 4were 10, 2, 3, 3, and 1.There was no mortality within 30 days.

Conclusions: Robotic left colon cancer resection using dual docking technique is safe and feasible. Our technique can be a suitable procedure to maximize the splenic mobilization.

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