Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

Abstract

In the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

In the era where laparoscopic colorectal surgery is well established, robotic-assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery [1, 2]. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

Standard robotic-assisted high anterior resection uses 3 robotic arms (scissors, cadiel forceps, and bipolar forceps), apart from the camera arm. In our practice, instead of utilizing all 3 arms, we use scissors and bipolar forceps only (Figs. 1 and 2). This is facilitated by positioning the port sites depicted in schematic Fig. 1. The positioning of the ports allows space for an additional port to be inserted for a 3^rd arm should additional retraction needed.

Fig. 1

Schematic diagram showing port placements employed in the “2-arm technique.” MCL midclavicular line, CM costal margin, ASIS anterior superior iliac spine, SP scissor port, AP assistant port, BP bipolar port

Fig. 2

Port placements during employed during “2-arm technique” for robotic-assisted high anterior resection

By using the 2-arm technique, we have shown that robotic high anterior resection can be performed safely and cost-effectively. This technique saves £180.00 ($240.00) for every robotic high anterior resection and has been successfully employed to treat 30 patients to date. We hope this method can be adopted widely and help make robotic-assisted colorectal surgery a more cost-effective and widely utilized procedure (Figure 3).

Fig. 3

Mounted arms for robotic-assisted high anterior resection

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