Ann Surg Treat Res.  2020 Jan;98(1):31-43. 10.4174/astr.2020.98.1.31.

Robotic surgery for colorectal disease: review of current port placement and future perspectives

• Lee JL
• Alsaleem H
• Kim JC

• KMID: 2466561
• DOI: http://doi.org/10.4174/astr.2020.98.1.31

Abstract

PURPOSE
As robotic surgery is increasingly performed in patients with colorectal diseases, understanding proper port placement for robotic colorectal surgery is necessary. This review summarizes current port placement during robotic surgery for colorectal diseases and provides future perspective on port placements.
METHODS
PubMed were searched from January 2009 to December 2018 using a combination of the search terms "robotic" [MeSH], "colon" [MeSH], "rectum" [MeSH], "colorectal" [MeSH], and "colorectal surgery" [MeSH]. Studies related to port placement were identified and included in the current study if they used the da Vinci S, Si, or Xi robotic system and if they described port placement.
RESULTS
This review included 77 studies including a total of 3,145 operations. Fifty studies described port placement for left-sided and mesorectal excision; 17, 3, and 7 studies assessed port placement for right-sided colectomy, rectopexy, transanal surgery, respectively; and one study assessed surgery with reduced port placement. Recent literatures show that the single-docking technique included mobilization of the second and third robotic arms for the different parts without movement of patient cart and similar to previous dual or triple-docking technique. Besides, use of the da Vinci Xi system allowed a more simplified port configuration.
CONCLUSION
Robot-assisted colorectal surgery can be efficiently achieved with successful port placement without movement of patient cart dependent on the type of surgery and the robotic system.

Keyword

Colon; Rectum; Robotics; Robotic surgical procedure; Surgery

MeSH Terms

Arm
Colectomy
Colon
Colorectal Surgery
Humans
Rectum
Robotic Surgical Procedures
Robotics

Figure

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  Fig. 1 A diagram of literature search and selection.

• 

  Fig. 2 Port placement for robotic total mesorectal excision (A–D) or left-sided colectomy (A, B) using the da Vinci S, Si, or Xi system. (A) Port placement for hybrid technique including laparoscopic splenic flexure or left colon mobilization. (B) Double docking port placement with movement of the patient cart according to the dissection area. (C) Single-docking port placement including the rotation of robotic arms without movement of patient cart. (D) Port placement recommended by the manufacturer using the da Vinci Xi system. Port placement for robotic right-sided colectomy (E–G) and ventral mesh rectopexy (H). (E) Reversed-L-shaped port placement with minor variation using the da Vinci S or Si system. (F) Suprapubic port placement with wound extension between the 2 suprapubic ports for the extraction of the specimen. (G) Port placement that was recommended by the manufacturer using the da Vinci Xi system. (H) Port placement with minor variations for robotic ventral mesh rectopexy that was focused on the pelvic dissection. Extraordinary port placement. (I) Reduced port placement for anterior resection using single-site platform with an additional port. (J) Universal port placement for all 4-quadrant colorectal surgery. R1, arm 1 for monopolar scissors or cautery hook; R2, arm 2 for Maryland or Fenestrated bipolar forceps; R3, arm 3 for tip-up fenestrated grasper or Cadiere forceps; A, assistant port; C, camera port; ASIS, anterior superior iliac supine; MCL, mid-clavicular line; SF, dissection for splenic flexure; P, dissection for pelvis; Docking, placement of the patient cart; S, single-site platform.

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