Universal suprapubic approach for complete mesocolic excision and central vascular ligation using the da Vinci Xi®system: from cadaveric models to clinical cases.
There has been little enthusiasm for performing robotic colectomy for colon cancer in recent years due to multiple factors, one being that the previous robotic systems such as the da Vinci Si®(dVSi) were poorly designed for multi-quadrant surgery. The new da Vinci Xi®(dVXi) system enables colectomy with central mesocolic excision to be performed easily in a single docking procedure. We developed a universal port placement strategy to allow right and left hemicolectomies to be performed via a suprapubic approach and a Pfannensteil extraction site. This proof of concept paper describes the development and subsequent clinical application of this setup. After extensive training on the dVXi system concepts in collaboration with clinical development engineers, we developed a port placement strategy which was tested and adapted after performing experimental surgery in three cadaveric models. Subsequently our port placement was used for two clinical cases of suprapubic right and left hemicolectomy. With some modifications of port placements after the initial cadaveric colectomies, we have developed a potentially universal suprapubic port placement strategy for robotic colectomy with complete mesocolic excision and central vascular ligation using the dVXi robotic system. This port placement strategy was applied successfully in our first two clinical cases. Based on our cadaveric laboratory as well as our initial clinical application, the suprapubic port placement strategy for the dVXi system with its improved features over the dVSi can feasibly perform right and left hemicolectomy with complete mesocolic excision and central vascular ligation. Further studies will be required to establish efficacy as well as safety profile of these procedures.
Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Shen Ann
SA
Yeo
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Gyoung Tae
GT
Noh
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Jeong Hee
JH
Han
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Chinock
C
Cheong
Department of Clinical Development Engineering, Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA.
Hubert
H
Stein
Department of Clinical Development Engineering, Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA.
Amy
A
Kerdok
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. bsmin@yuhs.ac.
Byung Soh
BS
Min
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000098:blood supply / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008026:Ligation; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*
Complete mesocolic excision; Left hemicolectomy; Right hemicolectomy; Robotic surgery; Suprapubic; da Vinci Xi