Techniques in Coloproctology

, Volume 21, Issue 1, pp 53–57 | Cite as

A novel approach for robotic mobilization of the splenic flexure

  • O. Isik
  • C. Benlice
  • E. GorgunEmail author



The techniques of robotic splenic flexure mobilization in the colorectal surgery setting are not well defined and have been challenging due to limited range of motion of the second-generation robotic platform in multiple quadrants.


This report describes a novel technique for robotic splenic flexure mobilization with medial-to-lateral approach without a need for robotic cart repositioning during left-sided colon and rectal surgery. The dissection is started with ligation of the inferior mesenteric artery and vein. Unique in this approach, entering the lesser sac is accomplished by extension of the dissection cranially by lifting up the mesocolon from the anterior surface of the pancreatic body toward the stomach.


This technique presented in the video allows the mobilization of the splenic flexure without excessive tractions and avoidance of potential splenic injuries.


The described novel approach demonstrates total robotic splenic flexure takedown without excessive traction, with improved visualization, and reduction of potential risk of splenic injury. This approach provides totally robotic mobilization of the splenic flexure at single docking without changing the patient’s position.


Splenic flexure mobilization Robotic surgery Single docking Colorectal surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study ethical approval is not necessary.

Informed consent

Informed consent was obtained from the patient.

Supplementary material

Supplementary material 1 (MP4 63141 kb)


  1. 1.
    Holubar SD, Wang JK, Wolff BG et al (2009) Splenic salvage after intraoperative splenic injury during colectomy. Arch Surg 144:1040–1045CrossRefPubMedGoogle Scholar
  2. 2.
    Masoomi H, Carmichael JC, Mills S, Ketana N, Dolich MO, Stamos MJ (2012) Predictive factors of splenic injury in colorectal surgery: data from the nationwide inpatient sample, 2006–2008. Arch Surg 147:324–329CrossRefPubMedGoogle Scholar
  3. 3.
    Malek MM, Greenstein AJ, Chin EH et al (2007) Comparison of iatrogenic splenectomy during open and laparoscopic colon resection. Surg Laparosc Endosc Percutan Tech 17:385–387CrossRefPubMedGoogle Scholar
  4. 4.
    Isik O, Snyder K, Aytac E, Kessler H, Gorgun E (2014) Laparoscopic technique decreases iatrogenic splenic injury rates during colorectal resections. Dis Colon Rectum 57:E168Google Scholar
  5. 5.
    Isik O, Aytac E, Ashburn J et al (2014) Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. Surg Endosc 29:1039–1044CrossRefPubMedGoogle Scholar
  6. 6.
    Cassar K, Munro A (2002) CLINICAL REVIEW-iatrogenic splenic injury. J R Coll Surg Edinb 47:731–741PubMedGoogle Scholar
  7. 7.
    Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19:140–146CrossRefPubMedGoogle Scholar
  8. 8.
    Alasari S, Min BS (2012) Robotic colorectal surgery: a systematic review. ISRN Surg 2012:293894CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    D’Annibale A, Morpurgo E, Fiscon V et al (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168CrossRefPubMedGoogle Scholar
  10. 10.
    Parra-Davila E, Diaz-Hernandez JJ (2011) Totally robotic left colectomy. J Robot Surg 5:57–64CrossRefPubMedGoogle Scholar
  11. 11.
    Decanini C, Milsom JW, Böhm B, Fazio VW (1994) Laparoscopic oncologic abdominoperineal resection. Dis Colon Rectum 37:552–558CrossRefPubMedGoogle Scholar
  12. 12.
    Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11:778–782CrossRefPubMedGoogle Scholar
  13. 13.
    Al-Asari SF, Lim D, Min BS, Kim NK (2013) The relation between inferior mesenteric vein ligation and collateral vessels to splenic flexure: anatomical landmarks, technical precautions and clinical significance. Yonsei Med J 54:1484–1490CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Skandalakis PN, Colborn GL, Skandalakis LJ, Richardson DD, Mitchell WE Jr, Skandalakis JE (1993) The surgical anatomy of the spleen. Surg Clin North Am 73:747–768CrossRefPubMedGoogle Scholar
  15. 15.
    Park JS, Kang SB, Kim DW, Lee KH, Kim YH (2009) Laparoscopic versus open resection without splenic flexure mobilization for the treatment of rectum and sigmoid cancer: a study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech 19:62–68CrossRefPubMedGoogle Scholar
  16. 16.
    Parra-Davila E, Ortiz-Ortiz CM (2014) Robotic left colectomy. In: Robotics in general surgery. Springer; 203-212Google Scholar
  17. 17.
    Bae SU, Baek SJ, Hur H, Baik SH, Kim NK, Min BS (2015) Robotic left colon cancer resection: a dual docking technique that maximizes splenic flexure mobilization. Surg Endosc 29:1303–1309CrossRefPubMedGoogle Scholar
  18. 18.
    Baik SH, Lee WJ, Rha KH et al (2008) Robotic total mesorectal excision for rectal cancer using four robotic arms. Surg Endosc 22:792–797CrossRefPubMedGoogle Scholar
  19. 19.
    Baek J, Pastor C, Pigazzi A (2011) Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Surg Endosc 25:521–525CrossRefPubMedGoogle Scholar
  20. 20.
    Hellan M, Stein H, Pigazzi A (2009) Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. Surg Endosc 23:447–451CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Colorectal Surgery, Digestive Disease InstituteCleveland ClinicClevelandUSA

Personalised recommendations