title: Telerobotic-assisted laparoscopic right hemicolectomy: lateral to medial or medial to lateral dissection?
abstract: BACKGROUND
  We previously reported that telerobotic-assisted laparoscopic colectomy was feasible and could be accomplished safely. Nonetheless, we found that the current iteration of da Vinci was not well suited to a lateral to medial (LtM) dissection of the colonic mesentery. The motion scaling made the large excursion arcs required for adequate exposure in a LtM dissection cumbersome to achieve.
  
  
  OBJECTIVE
  As a result, the aim of this study was to compare the ability of the da Vinci telerobotic surgical system to perform telerobotic-assisted laparoscopic right hemicolectomy using a LtM dissection with a medial to lateral (MtL) dissection technique.
  
  
  METHODS
  We compared 8 consecutive da Vinci-assisted laparoscopic right hemicolectomies performed using a LtM dissection to 8 consecutive operations using a MtL dissection technique. Results were compared using analysis of variance.
  
  
  RESULTS
  Age for the 2 groups were not significantly different: LtM 64 (43 to 71) years and MtL 56 (39 to 68) years. Body mass index was similar: LtM 27 (22 to 34) and MtL 25 (20 to 32) kg/m. Total surgical time (including cystoscopy and intraoperative colonoscopy) were similar: LtM 212 (188 to 610) minutes and MtL 203 (135 to 220) minutes. There was no significant difference in lymph node harvest: LtM 12 (3 to 20) lymph nodes and MtL 18 (3 to 35) lymph nodes. There were no deaths or anastomotic leaks in either groups. Median length of stay was similar for both groups: LtM 5 (3 to 10) days and MtL 4 (2 to 9) days.
  
  
  CONCLUSIONS
  da Vinci-assisted laparoscopic right hemicolectomy using a MtL dissection technique achieves similar outcomes as a LtM dissection approach.
authors.affiliation: Division of Minimally Invasive and Telerobotic Surgery, Hackensack University Medical Center, Hackensack, NJ 07601, USA. ghb@lapsurgery.com
authors.forename: Garth H
authors.initials: GH
authors.lastname: Ballantyne
authors.forename: Douglas
authors.initials: D
authors.lastname: Ewing
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Annette
authors.initials: A
authors.lastname: Wasielewski
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003111:Colonic Polyps / Q000601:surgery; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012371:Robotics