Abstract
laparoscopy surgery has many proven clinical advantages over conventional surgery and more recently, robotic surgery has been the emerging platform in the minimally invasive era. In the colorectal field, although overcoming limitations of standard laparoscopy, robotic surgery still faces challenging situations even by the most experienced colorectal surgeons. This study reports essentials technical aspects and comparison between Da Vincis Si and Xi platforms aiming to master and maximize efficiency whenever performing robotic colorectal surgery. this study overviews the most structured concepts and practical applications in robotic colorectal surgery in both Si and Xi Da Vinci platforms. Possible pitfalls are emphasized and step-wise approach is described from port placement and docking process to surgical technique. We also present data collected from a prospectively maintained database. our early experience includes forty-four patients following a standardized total robotic left-colon and rectal resection. Guided information and practical applications for a safe and efficient robotic colorectal surgery are described. We also present illustrations and describe technical aspects of a standardized procedure. performing robotic colorectal surgery is feasible and safe in experienced surgeons hands. Although the Da Vinci Xi platform demonstrates greater versatility in a more user-friendly design with technological advances, the correct mastery of technology by the surgical team is an essential condition for its fully robotic execution in a single docking approach.
Highlights
The benefits of laparoscopy for colorectal surgery have been demonstrated over the last years, showing non-inferiority oncological outcomes compared to conventional open surgery, whereas patient recovery and other short-term outcomes measures are improved
We aimed to describe and guide technical aspects applied to a total robotic colorectal surgery, showing differences between both Si and Xi systems and assuring the maximum efficiency especially in left-sided colon and rectal surgery
Our early experience includes a total of fortyfour patients who underwent this reported standardized robotic high or low anterior resections, for benign and malignant diseases
Summary
The benefits of laparoscopy for colorectal surgery have been demonstrated over the last years, showing non-inferiority oncological outcomes compared to conventional open surgery, whereas patient recovery and other short-term outcomes measures are improved. Limited range of motion of the rigid instruments, unstable image from a handheld camera and limited visibility in the pelvis, associated with rectal resections, are widespread technical challenges. A high definition three-dimensional stereoscopic vision and magnification, improved ergonomics, wristed instruments and an intuitive stable and surgeon guided camera added to superior range of motion and freedom of movements are remarkable advantages[2]. To initial laparoscopy, incorporation of robotic surgery demanded another surgeon’s learning curve and apprenticeship of technical aspects in a “new concept” of minimally invasive surgery.
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