Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases

Abstract

Background

This study aimed to evaluate the feasibility of using a robotic assistant for colon resections. This report describes the experience, advantages, and disadvantages of using the DaVinci system for a colectomy on the basis of 30 consecutive cases managed by a minimally invasive surgery fellowship–trained surgeon.

Methods

Data were prospectively collected on 30 consecutive colectomies performed using the DaVinci system from September 2002 to March 2005.

Results

A total of 13 sigmoid colectomies with splenic flexure mobilization and 17 right colectomies were performed for 14 men and 16 women. The preoperative diagnoses for the procedures were cancer (n = 5), diverticulitis (n = 8), polyps (n = 16), and carcinoid (n = 1). The right colectomies required 29.7 ± 6.7 min (range, 22–44 min) for the port setup, 177.1 ± 50.6 min (range, 103–306 min) for the robot, and 218.9 ± 44.6 min (range, 167–340 min) for the total case. The length of stay was 5.2 ± 5.8 days (range, 2–27 days). The robot portion was 80.9% of the total case time. The sigmoid colectomies required 30.1 ± 9.6 min (range, 15–50 min) for the port setup, 103.2 ± 29.4 min (range, 69–165 min) for the robot, and 225.2 ± 37.1 min (range, 147–283 min) for the total case. The hospital length of stay was 6.0 ± 7.3 days (range, 3–30 days). The robot portion was 45.8% of the total case time. Six complications occurred: left hip paresthesia, cecal injury, anastomotic leak, patient slipped from the operating table after the robotic portion of the case, transverse colon injury, and return of a patient to the office with urinary retention. Two sigmoid colectomies were converted to laparotomy. The specific advantages and disadvantages of using the DaVinci system for colectomies are discussed.

Conclusions

The 30 consecutive cases demonstrated the technical feasibility of using the DaVinci system for a colectomy. The longevity of the DaVinci system’s use for colectomy will be determined by comparison of its cost and outcomes with those for conventional laparoscopic colectomy.