Robotic left colon cancer resection: a dual docking technique that maximizes splenic flexure mobilization

Techniques for robotic resection of the left colon are not well defined and have not been widely adopted due to limited range of motion of the robotic arms. We have developed a dual docking technique for both the splenic flexure and the pelvis. We report our initial experience of robotic left colectomy using this technique for left-sided colon cancer. The study group comprised 61 patients who underwent robotic left colon cancer resection using our dual docking technique between July 2008 and January 2013. Operations comprised two stages: colon mobilization (stage 1) followed by pelvic dissection (stage 2). After completion of stage 1, the robot arms were undocked and the operating table was rotated 60A degrees counterclockwise until a 45A degrees angle was created between the patient cart and the operating table. All 61 procedures were technically successful without the need for conversion to laparoscopic or open surgery. Median total operation, 1st docking, and 2nd docking times were 227 min (range, 137-653 min), 4 min (range, 3-8 min), and 3 min (range, 3-9 min), respectively. Estimated blood loss was 20 ml (range, 20-2,000 ml). Median time to soft diet was 2 days (range, 2-12 days) and median length of hospital stay was 7 days (range, 4-20 days). Median total number of lymph nodes harvested was 17 (range, 3-61). According to the Clavien-Dindo classification, the numbers of complications for grades 1, 2, 3a, 3b, and 4 were 10, 2, 3, 3, and 1. There was no mortality within 30 days. Robotic left colon cancer resection using our dual docking technique is safe and feasible. This procedure can maximize splenic mobilization in robotic colorectal surgery.