Totally robotic complete mesocolic excision for right-sided colon cancer

  • Volkan Ozben
  • Erman Aytac
  • Deniz Atasoy
  • Ilknur Erenler Bayraktar
  • Onur Bayraktar
  • Ipek Sapci
  • Bilgi Baca
  • Tayfun Karahasanoglu
  • Ismail Hamzaoglu
Original Article


Complexity and operative risks of complete mesocolic excision (CME) seem to be important drawbacks to generalize this procedure in the surgical treatment of right colon cancer. Robotic systems have been developed to improve quality and outcomes of minimal invasive surgery. The aim of this study was to evaluate the feasibility of robotic right-sided CME and present our initial experience. A retrospective review of 37 patients undergoing totally robotic right-sided CME between February 2015 and November 2017 was performed. All the operations were carried out using the key principles of both CME with intracorporeal anastomosis and no-touch technique. Data on perioperative clinical findings and short-term outcomes were analyzed. There were 20 men and 17 women with a mean age of 64.4 ± 13.5 years and a body mass index of 26.8 ± 5.7 kg/m2. The mean operative time and estimated blood loss were 289.8 ± 85.3 min and 77.4 ± 70.5 ml, respectively. Conversion to laparoscopy occurred in one patient (2.7%). All the surgical margins were clear and the mesocolic plane surgery was achieved in 27 (72.9%) of the cases. The mean number of harvested lymph nodes was 41.8 ± 11.9 (median, 40; range 22–65). The mean length of hospital stay was 6.6 ± 3.7 days. The intraoperative and postoperative complication rates were 5.4 and 21.6%, respectively. We believe that use of robot for right-sided CME is feasible and appears to provide remarkably a high number of harvested lymph nodes with good specimen quality.


Right-sided colon cancer Complete mesocolic excision Robotic surgery Feasibility 



No funding or financial support was received for the study.

Compliance with ethical standards

Conflict of interest

Authors Volkan Ozben, Erman Aytac, Deniz Atasoy, Ilknur Erenler Bayraktar, Onur Bayraktar, Ipek Sapci, Bilgi Baca, Tayfun Karahasanoglu and Ismail Hamzaoglu declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 11:354–364CrossRefPubMedGoogle Scholar
  2. 2.
    Søndenaa K, Quirke P, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 29:419–428CrossRefPubMedGoogle Scholar
  3. 3.
    West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278CrossRefPubMedGoogle Scholar
  4. 4.
    Gouvas N, Agalianos C, Papaparaskeva K, Perrakis A, Hohenberger W, Xynos E (2016) Surgery along the embryological planes for colon cancer: a systematic review of complete mesocolic excision. Int J Colorectal Dis 31:1577–1594CrossRefPubMedGoogle Scholar
  5. 5.
    Siani LM, Pulica C (2015) Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg 104:219–226CrossRefPubMedGoogle Scholar
  6. 6.
    Huang JL, Wei HB, Fang JF, Zheng ZH, Chen TF, Wei B, Huang Y, Liu JP (2015) Comparison of laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg 23:12–17CrossRefPubMedGoogle Scholar
  7. 7.
    Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2014) Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol 21:2288–2294CrossRefPubMedGoogle Scholar
  8. 8.
    Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767CrossRefPubMedGoogle Scholar
  9. 9.
    Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP (2016) Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 68:63–69CrossRefPubMedGoogle Scholar
  10. 10.
    Ogino T, Takemasa I, Horitsugi G, Furuyashiki M, Ohta K, Uemura M, Nishimura J, Hata T, Mizushima T, Yamamoto H, Doki Y, Mori M (2014) Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer. Ann Surg Oncol 21(Suppl 3):S429–S435CrossRefPubMedGoogle Scholar
  11. 11.
    Açar H, Cömert A, Avşar A, Çelik S, Kuzu MA (2014) Dynamic article: surgical anatomical planes for complete mesocolic excision and applied vascular anatomy of the right colon. Dis Colon Rectum 57:1169–1175CrossRefPubMedGoogle Scholar
  12. 12.
    D’Annibale A, Pernazza G, Morpurgo E, Monsellato I, Pende V, Lucandri G, Termini B, Orsini C, Sovernigo G (2010) Robotic right colon resection: evaluation of first 50 consecutive cases for malignant disease. Ann Surg Oncol 17:2856–2862CrossRefPubMedGoogle Scholar
  13. 13.
    Zimmern A, Prasad L, Desouza A, Marecik S, Park J, Abcarian H (2010) Robotic colon and rectal surgery: a series of 131 cases. World J Surg 34:1954–1958CrossRefPubMedGoogle Scholar
  14. 14.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ozben V, Baca B, Atasoy D, Bayraktar O, Aghayeva A, Cengiz TB, Erguner I, Karahasanoglu T, Hamzaoglu I (2016) Robotic complete mesocolic excision for right-sided colon cancer. Surg Endosc 30:4624–4625CrossRefPubMedGoogle Scholar
  16. 16.
    Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tanaka T, Shimada E, Kakeji Y (2015) Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy. Surg Endosc 29:1001CrossRefPubMedGoogle Scholar
  17. 17.
    Matsuda T, Iwasaki T, Sumi Y, Yamashita K, Hasegawa H, Yamamoto M, Matsuda Y, Kanaji S, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y (2017) Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration. Int J Colorectal Dis 32:139–141CrossRefPubMedGoogle Scholar
  18. 18.
    Isik O, Gorgun E (2015) How has the robot contributed to colon cancer surgery? Clin Colon Rectal Surg 28:220–227CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Trastulli S, Desiderio J, Farinacci F, Ricci F, Listorti C, Cirocchi R, Boselli C, Noya G, Parisi A (2013) Robotic right colectomy for cancer with intracorporeal anastomosis: short-term outcomes from a single institution. Int J Colorectal Dis 28:807–814CrossRefPubMedGoogle Scholar
  20. 20.
    Mathew R, Kim SH (2013) Robotic right hemicolectomy with D3 lymphadenectomy and complete mesocolic excision: technical detail. OA Rob Surg 1:6Google Scholar
  21. 21.
    Bae SU, Jeong WK, Baek SK (2017) Robotic complete mesocolic excision and intracorporeal anastomosis using a robotic stapler for right-sided colon cancer with reduced-port access. Dis Colon Rectum 60:456CrossRefPubMedGoogle Scholar
  22. 22.
    Trastulli S, Coratti A, Guarino S, Piagnerelli R, Annecchiarico M, Coratti F, Di Marino M, Ricci F, Desiderio J, Cirocchi R, Parisi A (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29:1512–1521CrossRefPubMedGoogle Scholar
  23. 23.
    Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441CrossRefPubMedGoogle Scholar
  24. 24.
    Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 166:420–427CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kanemitsu Y, Komori K, Kimura K, Kato T (2013) D3 Lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum 56:815–824CrossRefPubMedGoogle Scholar
  26. 26.
    García-Olmo D, Ontañón J, García-Olmo DC, Vallejo M, Cifuentes J (1999) Experimental evidence does not support use of the “no-touch” isolation technique in colorectal cancer. Dis Colon Rectum 42:1449–1456CrossRefPubMedGoogle Scholar
  27. 27.
    Takii Y, Shimada Y, Moriya Y, Nakamura K, Katayama H, Kimura A, Shibata T, Fukuda H, Colorectal Cancer Study Group (CCSG) of Japan Clinical Oncology Group (2014) A randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colorectal cancer: Japan Clinical Oncology Group Study JCOG1006. Jpn J Clin Oncol 44:97–100CrossRefPubMedGoogle Scholar
  28. 28.
    Tarta C, Bishawi M, Bergamaschi R (2013) Intracorporeal ileocolic anastomosis: a review. Tech Coloproctol 17:479–485CrossRefPubMedGoogle Scholar
  29. 29.
    Benlice C, Stocchi L, Costedio MM, Gorgun E, Kessler H (2016) Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 59:743–750CrossRefPubMedGoogle Scholar
  30. 30.
    Erguner I, Aytac E, Boler DE, Atalar B, Baca B, Karahasanoglu T, Hamzaoglu I, Uras C (2013) What have we gained by performing robotic rectal resection? Evaluation of 64 consecutive patients who underwent laparoscopic or robotic low anterior resection for rectal adenocarcinoma. Surg Laparosc Endosc Percutan Tech 23:316–319CrossRefPubMedGoogle Scholar
  31. 31.
    Ozben V, Cengiz TB, Atasoy D, Bayraktar O, Aghayeva A, Erguner I, Baca B, Hamzaoglu I, Karahasanoglu T (2016) Is da Vinci Xi better than da Vinci Si in robotic rectal cancer surgery? Comparison of the 2 generations of da Vinci Systems. Surg Laparosc Endosc Percutan Tech 26:417–423CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Volkan Ozben
    • 1
  • Erman Aytac
    • 1
  • Deniz Atasoy
    • 1
  • Ilknur Erenler Bayraktar
    • 1
  • Onur Bayraktar
    • 1
  • Ipek Sapci
    • 2
  • Bilgi Baca
    • 1
  • Tayfun Karahasanoglu
    • 1
  • Ismail Hamzaoglu
    • 1
  1. 1.Department of General SurgeryAcibadem Mehmet Ali Aydinlar University, School of MedicineIstanbulTurkey
  2. 2.School of MedicineAcibadem Mehmet Ali Aydinlar UniversityIstanbulTurkey

Personalised recommendations