title: Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences.
abstract: OBJECTIVE
  Telerobotic surgery is a developing and promising modality that highly improves the laparoscopic dexterity. We have performed more than 100 laparoscopic and thoracoscopic procedures since December 2002 with the aid of the Da Vinci robotic system. This study was designed to assess the value of robots in colonic laparoscopic surgery. We present our first cases of robotic-assisted colectomies.
  
  
  METHODS
  Two patients underwent a telerobotic-assisted sigmoidectomy for sigmadiverticulitis. One of these cases was complicated with a sigmoid-bladder fistula. Three other patients were submitted to a colon resection for cancer: sigmoidectomy (n = 2), and right colectomy (n = 1). A four-trocar technique was used for all operations. Tissue dissection of colonic adhesions, mobilization of the colon, management of the fistula, mesenteric dissection and division, and bowel resection were fully performed with the telerobotic system.
  
  
  RESULTS
  Three operations were completed using the Da Vinci system without any problems in acceptable times. In two patients, the operation had to be converted to laparotomy because of severe adhesions and locally extended tumor growth. Postoperative courses of all patients were uneventful. Patients were discharged between postoperative Days 9 and 20, and were well six months later.
  
  
  CONCLUSIONS
  Colonic telerobotic surgery can be performed safely. Benefits were seen during dissection of the rectum in the small pelvis. A major limitation is a lack of a large operation field especially if there is the need to dissect a colonic flexure in the upper abdomen. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of the telerobotic surgery.
authors.affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Medical Faculty Charité, Humboldt University, Berlin, Germany.
authors.forename: Chris
authors.initials: C
authors.lastname: Braumann
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Jacobi
authors.forename: Charalambos
authors.initials: C
authors.lastname: Menenakos
authors.forename: Ulrich
authors.initials: U
authors.lastname: Borchert
authors.forename: Jens C
authors.initials: JC
authors.lastname: Rueckert
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012371:Robotics