Abstract
Background
The techniques of robotic splenic flexure mobilization in the colorectal surgery setting are not well defined and have been challenging due to limited range of motion of the second-generation robotic platform in multiple quadrants.
Methods
This report describes a novel technique for robotic splenic flexure mobilization with medial-to-lateral approach without a need for robotic cart repositioning during left-sided colon and rectal surgery. The dissection is started with ligation of the inferior mesenteric artery and vein. Unique in this approach, entering the lesser sac is accomplished by extension of the dissection cranially by lifting up the mesocolon from the anterior surface of the pancreatic body toward the stomach.
Results
This technique presented in the video allows the mobilization of the splenic flexure without excessive tractions and avoidance of potential splenic injuries.
Conclusions
The described novel approach demonstrates total robotic splenic flexure takedown without excessive traction, with improved visualization, and reduction of potential risk of splenic injury. This approach provides totally robotic mobilization of the splenic flexure at single docking without changing the patient’s position.
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References
Holubar SD, Wang JK, Wolff BG et al (2009) Splenic salvage after intraoperative splenic injury during colectomy. Arch Surg 144:1040–1045
Masoomi H, Carmichael JC, Mills S, Ketana N, Dolich MO, Stamos MJ (2012) Predictive factors of splenic injury in colorectal surgery: data from the nationwide inpatient sample, 2006–2008. Arch Surg 147:324–329
Malek MM, Greenstein AJ, Chin EH et al (2007) Comparison of iatrogenic splenectomy during open and laparoscopic colon resection. Surg Laparosc Endosc Percutan Tech 17:385–387
Isik O, Snyder K, Aytac E, Kessler H, Gorgun E (2014) Laparoscopic technique decreases iatrogenic splenic injury rates during colorectal resections. Dis Colon Rectum 57:E168
Isik O, Aytac E, Ashburn J et al (2014) Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. Surg Endosc 29:1039–1044
Cassar K, Munro A (2002) CLINICAL REVIEW-iatrogenic splenic injury. J R Coll Surg Edinb 47:731–741
Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19:140–146
Alasari S, Min BS (2012) Robotic colorectal surgery: a systematic review. ISRN Surg 2012:293894
D’Annibale A, Morpurgo E, Fiscon V et al (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168
Parra-Davila E, Diaz-Hernandez JJ (2011) Totally robotic left colectomy. J Robot Surg 5:57–64
Decanini C, Milsom JW, Böhm B, Fazio VW (1994) Laparoscopic oncologic abdominoperineal resection. Dis Colon Rectum 37:552–558
Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11:778–782
Al-Asari SF, Lim D, Min BS, Kim NK (2013) The relation between inferior mesenteric vein ligation and collateral vessels to splenic flexure: anatomical landmarks, technical precautions and clinical significance. Yonsei Med J 54:1484–1490
Skandalakis PN, Colborn GL, Skandalakis LJ, Richardson DD, Mitchell WE Jr, Skandalakis JE (1993) The surgical anatomy of the spleen. Surg Clin North Am 73:747–768
Park JS, Kang SB, Kim DW, Lee KH, Kim YH (2009) Laparoscopic versus open resection without splenic flexure mobilization for the treatment of rectum and sigmoid cancer: a study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech 19:62–68
Parra-Davila E, Ortiz-Ortiz CM (2014) Robotic left colectomy. In: Robotics in general surgery. Springer; 203-212
Bae SU, Baek SJ, Hur H, Baik SH, Kim NK, Min BS (2015) Robotic left colon cancer resection: a dual docking technique that maximizes splenic flexure mobilization. Surg Endosc 29:1303–1309
Baik SH, Lee WJ, Rha KH et al (2008) Robotic total mesorectal excision for rectal cancer using four robotic arms. Surg Endosc 22:792–797
Baek J, Pastor C, Pigazzi A (2011) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25:521–525
Hellan M, Stein H, Pigazzi A (2009) Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. Surg Endosc 23:447–451
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Selected for video presentation for the Ongoing Video Room at the upcoming ASCRS Annual Scientific Meeting, April 30–May 4, 2016, Los Angeles, CA.
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Isik, O., Benlice, C. & Gorgun, E. A novel approach for robotic mobilization of the splenic flexure. Tech Coloproctol 21, 53–57 (2017). https://doi.org/10.1007/s10151-016-1572-x
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DOI: https://doi.org/10.1007/s10151-016-1572-x