Full robotic left colon and rectal cancer resection: technique and early outcome.
OBJECTIVE
The technique for robotic resection of the left colon and anterior resection of the rectum with total mesorectal excision is not well defined. In this study we describe a method that standardizes robot and trocar position, and allows for a complete mobilization of the left colon and the rectum, without repositioning of the surgical cart. Outcome and pathology findings are also reported.


METHODS
From January 2007 to May 2008 a total of 55 consecutive patients affected by rectal and left colon cancer were operated on, with full robotic technique, using the Da Vinci robot. Data regarding outcome and pathology reports were prospectively collected in a dedicated database.


RESULTS
The following procedures were performed 27 left colectomies, 17 anterior resections, 4 intersphincteric resections, 7 abdominoperineal resections. There were 21 female and 34 male patients with a mean age of 63 +/- 9.9 years. Mean operative time was 290 +/- 69 minutes, ranging from 164 to 487 min., none were converted to open surgery. The median number of lymph nodes harvested was 18.5 +/- 8.3 (range 5-45), and circumferential margin was negative in all cases. Distal margin was 25.15 +/- 12.9 mm (range 6-55) for patients with rectal cancer, and 31.6 +/- 20 mm for all the patients in this series. Anastomotic leak rate was 12.7% (7/55); in all cases conservative treatment was successful.


CONCLUSIONS
Full robotic colorectal surgery is a safe and effective technique that exploits the advantages of the Da Vinci robot during the whole intervention, without the need to make use of hybrid operations. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures.
Luca
Fabrizio
F
Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Milano, Italy. fabrizio.luca@ieo.it
Cenciarelli
Sabine
S
Valvo
Manuela
M
Pozzi
Simonetta
S
Faso
Felice Lo
FL
Ravizza
Davide
D
Zampino
Giulia
G
Sonzogni
Angelica
A
Biffi
Roberto
R
D000368:Aged; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012371:Robotics; D016896:Treatment Outcome