VM41 - Robotic Single Port Right Hemicolectomy: Our Experience

Purpose/Background: The introduction of robotics to colorectal surgery has drastically changed our ability to care for these patients. The robotic platform is unique in that it allows for improved dexterity, decreased tissue manipulation, improved postoperative pain control, decreased length of stay, and earlier returned to work following surgery. The transition from the Si to XI da Vinci robot was revolutionary by allowing surgeons to operate in multiple quadrants of the abdomen. However, there remains issues with camera angles, internal and external instrument collisions, and sub- optimal arm placement when operating in multiple quadrants. The introduction of the single port system seeks to address these issues. This is a new device that allows for one incision with a flexible camera and three arms. These can be moved throughout the abdomen as one unit which minimizes collisions and improves visualization. This product is currenting still under development and is undergoing FDA trials.

Methods/Interventions: Here we would like to demonstrate our experience in using this device to perform a right hemicolectomy through a single Pfannenstiel incision. The single port da Vinci robot from Intuitive Surgical was used through an FDA trial. We demonstrate the function of the platform, use of three robotic arms and assistant, and the surgical technique used. We demonstrate lateral to medial mobilization of the colon to allow for exposure for the assistant.

Results/Outcomes: We were able to successfully complete a right hemicolectomy using a single Pfannenstiel incision. The patient was able to tolerate the procedure well and we show the postoperative scar at the end of the video.

Conclusion/Discussion: We feel that this device allows for visualization, dexterity, tissue manipulation that can be difficult but comparable to the current systems. The single port device allows for multi quadrant surgery by moving the camera in conjunction with all three arms to center on the quadrant being operated in. It minimizes internal and external arm collision, and the flexible camera allows for visualization around the robotic arms and the bedside assistant. It also can depict the relation of the arms to each other through a graphic at the bottom of the surgeon’s screen on the console. We did find limitations in the reach and distance each arm could move when operating in a specific quadrant. Additionally, there are no energy or stapler devices currently compatible with the system and require the use of a bedside assistant. We found that communication between the operating surgeon and bedside assistant was crucial in being able to successfully complete this case. It is our hope that this new device will Enhance the techniques that we are able to offer our patients in the operating room.