Robotic-assisted single-incision laparoscopic partial cecectomy.
BACKGROUND
Single-incision laparoscopic surgery is an emerging approach in the field of minimally invasive colon and rectal surgery. This modality utilizes a 'scarless' incision concealed within the umbilicus, and results in improved cosmesis with the potential for reduced trauma, pain and length of hospital stay. However, unique technical challenges have curbed its adaptation. Robotic-assisted technique may help overcome these limitations when applied to the single-incision approach.


METHODS
A robotic-assisted single-incision laparoscopic partial cecectomy was performed using the da Vinci robot and the GelPOINT access device. Modifications of the robotic set-up were utilized to optimize the technique. The robotic instruments were crossed below the abdominal wall to minimize internal conflict and maximize range of motion. Control of the robotic arms was reassigned on the robotic console to create a more intuitive surgical approach. The robotic camera was rotated and positioned vertically to reduce external conflict and enhance visualization.


RESULTS
Robotic-assisted single-incision laparoscopic partial cecectomy was performed in a 53 year-old male without complication or need for conversion. The procedure required 120 min with an estimated blood loss of < 50 ml. Pathology revealed a sessile tubular adenoma of the cecum. The length of hospital stay was 2 days and no complications were encountered. The patient returned with a well-healed 2.5 cm incision and no postoperative complications at 6 weeks follow-up.


CONCLUSIONS
With appropriate modifications, robotic-assisted single-incision laparoscopic surgery may be applicable as a minimally invasive modality for partial colectomy. Further studies are warranted to establish the safety, efficacy, benefits, and limits of this technique.
Ragupathi
Madhu
M
Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, TX, USA.
Ramos-Valadez
Diego I
DI
Pedraza
Rodrigo
R
Haas
Eric M
EM
D002432:Cecum / Q000000981:diagnostic imaging / Q000601:surgery*; D003113:Colonoscopy; D015902:Gamma Cameras; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011859:Radiography; D012371:Robotics / Q000295:instrumentation* / Q000379:methods*