Skip to main content
SpringerLink
Log in

Standardize the Surgical Technique and Clarify the Relevant Anatomic Concept for Complete Mobilization of Colonic Splenic Flexure Using da Vinci Xi® Robotic System

  • Original Scientific Report with Video
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The present study is to set up a standardized approach for complete mobilization of colonic splenic flexure using da Vinci Xi® robotic system, based on clarification of the mesenteric structures of distal transverse colon.

Methods

The surgical outcomes and relevant anatomic structures of 104 consecutive patients undergoing robotic resection of primary colorectal cancer with the intent of complete mobilization of colonic splenic flexure using da Vinci Xi® robotic system were retrospectively reviewed.

Results

Complete mobilization of colonic splenic flexure can be efficiently performed by the Xi® robotic system, as demonstrated by short operation time, minimal intra-operative blood loss, and few surgical complications. Xi® robotic system has overcome the drawbacks of Si® robotic system for the mobilization of colonic splenic flexure. The present study defined the following anatomic hallmarks for the colonic splenic flexure: (1) The transverse mesocolon distal to the inferior mesenteric vein adheres to the low border of pancreas by the avascular fibrous connective tissues, which have been inappropriately named as “mesenteric root”; (2) The colonic splenic flexure abuts closely to spleen with an acute angle in 78.85% (n = 82/104); (3) Only a minority of patients presented with the Riolan branch (15.38%, n = 16/104) or the Moskowitz artery (8.65%, n = 9/104).

Conclusion

With increased maneuverability of Xi® robotic arms and the clarification of relevant anatomic concept, the surgical technique for the complete mobilization of colonic splenic flexure can be standardized; and the standardization of surgical technique is the first step toward the enhanced automation in the rapidly evolving robotic systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Marsden MR, Conti JA, Zeidan S et al (2012) The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections. Colorectal Dis 14:1255–1261

    Article  PubMed  CAS  Google Scholar 

  2. Brennan DJ, Moynagh M, Brannigan AE et al (2007) Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum 50:302–307

    Article  PubMed  CAS  Google Scholar 

  3. Jamali FR, Soweid AM, Dimassi H et al (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767

    Article  PubMed  Google Scholar 

  4. Akiyoshi T, Kuroyanagi H, Oya M et al (2010) Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer. Surg Endosc 24:2749–2754

    Article  PubMed  Google Scholar 

  5. Liang JT, Lee PH (2005) Laparoscopic medial-to-lateral approach for the curative left hemicolectomy. Dis Colon Rectum 48:2142–2143

    Article  Google Scholar 

  6. Okuda J, Yamamoto M, Tanaka K et al (2016) Laparoscopic resection of transverse colon cancer at splenic flexure: technical aspects and results. Updates Surg 68:71–75

    Article  PubMed  Google Scholar 

  7. Benseler V, Hornung M, Iesalnieks I et al (2012) Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection. Int J Colorectal Dis 27:1521–1529

    Article  PubMed  Google Scholar 

  8. Matsuda T et al (2015) A 3-step method for laparoscopic mobilization of the splenic flexure. Ann Surg Oncol 22(Suppl 3):S335. https://doi.org/10.1245/s10434-015-4637-6

    Article  PubMed  Google Scholar 

  9. Matsuda T et al (2017) Anatomical and embryological perspectives in laparoscopic complete mesocoloic excision of splenic flexure cancers. Surg Endosc. https://doi.org/10.1007/s00464-017-5792-6

    Article  PubMed Central  PubMed  Google Scholar 

  10. Koh DC, Tsang CB, Kim SH (2011) A new application of the four-arm standard da Vinci surgical system: totally robotic-assisted left-sided colon or rectal resection. Surg Endosc 25:1945–1952

    Article  PubMed  Google Scholar 

  11. Liang JT (2014) Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer. Surg Endosc 28:1727–1733

    Article  PubMed  Google Scholar 

  12. Bae SU, Baek SJ, Hur H et al (2015) Robotic left colon cancer resection: a dual docking technique that maximizes splenic flexure mobilization. Surg Endosc 29:1303–1309

    Article  PubMed  Google Scholar 

  13. Isik O, Benlice C, Gorgun E (2017) A novel approach for robotic mobilization of the splenic flexure. Tech Coloproctol 21:53–57

    Article  PubMed  CAS  Google Scholar 

  14. Ahmed J, Kuzu MA, Figueiredo N et al (2016) Three-step standardized approach for complete mobilization of the splenic flexure during robotic rectal cancer surgery. Colorectal Dis 18:O171–O174

    Article  PubMed  CAS  Google Scholar 

  15. Morelli L, Guadagni S, Di Franco G et al (2015) Use of the new Da Vinci Xi during robotic rectal resection for cancer: technical considerations and early experience. Int J Colorectal Dis 30:1281–1283

    Article  PubMed  Google Scholar 

  16. Lange JF, Komen N, Akkerman G, Nout E, Horstmanshoff H, Schlesinger F, Bonjer J, Kleinrensink GJ (2007) Riolan’s arch: confusing, misnomer, and obsolete A literature survey of the connection(s) between the superior and inferior mesenteric arteries. Am J Surg 193:742–748

    Article  PubMed  Google Scholar 

  17. Garcia-Granero A, Sánchez-Guillén L, Carreño O et al (2017) Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study. Tech Coloproctol 21:567–572

    Article  PubMed  CAS  Google Scholar 

  18. van Gulik TM, Schoots I (2005) Anastomosis of Riolan revisited: the meandering mesenteric artery. Arch Surg 140:1225–1229

    Article  PubMed  Google Scholar 

  19. Toh JWT, Matthews R, Kim SH (2018) Arc of riolan-preserving splenic flexure takedown during anterior resection: potentially critical to prevent acute anastomotic ischemia. Dis Colon Rectum 61:411–414

    Article  PubMed  Google Scholar 

  20. Coffey JC, O’Leary DP (2016) The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 1:238–247

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study received research grant from Ministry of Science and Technology (103-2314-B-002-121-MY2).

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan, ROC

    Jin-Tung Liang, John Huang & Tzu-Chun Chen

Authors
  1. Jin-Tung Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tzu-Chun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin-Tung Liang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 81694 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liang, JT., Huang, J. & Chen, TC. Standardize the Surgical Technique and Clarify the Relevant Anatomic Concept for Complete Mobilization of Colonic Splenic Flexure Using da Vinci Xi® Robotic System. World J Surg 43, 1129–1136 (2019). https://doi.org/10.1007/s00268-018-04882-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-04882-z

Search

Navigation