A standardized technique for robotically performed sigmoid colectomy

Background: We describe a standarized eight-step technique to perform sigmoid colectomy using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) in both the left upper and lower abdominal quadrants. Materials and Methods: Between March 2005 and June 2006, 11 robotic sigmoid colectomies were performed on patients with diverticulitis or cancer. The procedures were performed through 4 ports, using a medial to lateral approach and involved moving the robot during the procedure. Results: We describe the data and results from our first 11 robotically performed sigmoid colectomies using this technique. Operative times during each step of the procedure were collected and reported. By the eighth case, our team required only 4 minutes to undock, move, and redock the robot. The average operative time was 197 minutes and the average length of hospital stay was 3.4 days. There were no complications and no conversions to open colectomy. Conclusion: Robotically performed sigmoid colectomy is a feasible and safe procedure. The robot can be moved efficiently during surgery to allow a totally robotically performed sigmoid colectomy. The three-dimensional view, articulating instruments, intuitive movement, motion scaling, stable camera platform, and comfortable surgeon ergonomics facilitate splenic flexure mobilization and dissection and division of the inferior mesenteric artery and inferior mesenteric vein. Further studies will be needed to determine clinical benefit and economic feasibility.