Robotic Surgery

  • Mehraneh Dorna JafariEmail author
  • David E. Rivadeneira
  • Alessio Pigazzi


Touting advantages of enhanced 3-dimensional visualization, improved ergonomics, unparalleled articulation and the opportunity for an enhanced ability to suture/operate in the deep pelvis, robotic approaches to colorectal surgery have seen tremendous growth over the past several years. While the debate over the application and utilization for robotics goes on, this platform continues to gain traction worldwide, and there is an increasing need to understand the potential advantages and disadvantages of robotic approaches, current indications, and technical tips to improve patient outcomes.


Total Mesorectal Excision Robotic Surgery Haptic Feedback Anterior Superior Iliac Spine Robotic Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Drs. Pigazzi and Rivadeneira serve as consultants for Intuitive Surgical (Sunnyvale, CA).

Supplementary material

Video 24.1

Laparoscopic ligation of the inferior mesenteric vein and artery using a combination of clips and vessel ligation (MPG 31346 kb)

Video 24.2

Recognition of hypogastric nerve during total mesorectal dissection (MPG 27170 kb)

Video 24.3

Total mesorectal dissection. The robotic arms allow for articulation in the narrow pelvis. This dissection is carried to the dentate line (MPG 173716 kb)

Video 24.4

Technique for single stapling technique and transanal specimen extraction (MPG 233708 kb)


  1. 1.
    Ballantyne GHMP, Weber A, Wasielewski A. Robotic solutions to the pitfalls of laparoscopic colectomy. Osp Ital Chir. 2001; 7(405):405–12.Google Scholar
  2. 2.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20(10):1521–5. PubMed PMID: 16897284.PubMedCrossRefGoogle Scholar
  3. 3.
    Weber PA, Merola S, Wasielewski A, Ballantyne GH. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45(12):1689–94. PubMed PMID: 12473897; discussion 95-6.PubMedCrossRefGoogle Scholar
  4. 4.
    Delaney CP, Lynch AC, Senagore AJ, Fazio VW. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum. 2003;46(12):1633–9. PubMed PMID: 14668588.PubMedCrossRefGoogle Scholar
  5. 5.
    D’Annibale A, Orsini C, Fiscon V, Trevisan P, Sovernigo G, Morpurgo E, et al. [Videolaparoscopic surgery in the treatment of colorectal disease: our experience with 200 patients]. Chirurgia italiana. 2002;54(6):777–83. PubMed PMID: 12613325. La chirurgia videolaparoscopica nel trattamento della patologia colo-rettale: nostra esperienza di 200 pazienti.PubMedGoogle Scholar
  6. 6.
    Braumann C, Jacobi CA, Menenakos C, Borchert U, Rueckert JC, Mueller JM. Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences. Dis Colon Rectum. 2005;48(9):1820–7. PubMed PMID: 16142433.PubMedCrossRefGoogle Scholar
  7. 7.
    Rawlings AL, Woodland JH, Crawford DL. Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc. 2006;20(11):1713–8. PubMed PMID: 17008953.PubMedCrossRefGoogle Scholar
  8. 8.
    Rawlings AL, Woodland JH, Vegunta RK, Crawford DL. Robotic versus laparoscopic colectomy. Surg Endosc. 2007;21(10):1701–8. PubMed PMID: 17353988.PubMedCrossRefGoogle Scholar
  9. 9.
    Hellan M, Anderson C, Ellenhorn JD, Paz B, Pigazzi A. Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol. 2007;14(11):3168–73. PubMed PMID: 17763911.PubMedCrossRefGoogle Scholar
  10. 10.
    Spinoglio G, Summa M, Priora F, Quarati R, Testa S. Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum. 2008;51(11):1627–32. PubMed PMID: 18484134.PubMedCrossRefGoogle Scholar
  11. 11.
    Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008; 22(7):1601–8. PubMed PMID: 18270772.PubMedCrossRefGoogle Scholar
  12. 12.
    Trastulli S, Farinella E, Cirocchi R, Cavaliere D, Avenia N, Sciannameo F, et al. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis. 2012;14(4):e134–56. PubMed PMID: 22151033.PubMedCrossRefGoogle Scholar
  13. 13.
    Halabi WJ, Kang CY, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, et al. Robotic-assisted colorectal surgery in the United States: a nationwide analysis of trends and outcomes. World J Surg. 2013;6. PubMed PMID: 23564216.Google Scholar
  14. 14.
    Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, et al. Dexterity enhancement with robotic surgery. Surg Endosc. 2004;18(5):790–5. PubMed PMID: 15216862.PubMedCrossRefGoogle Scholar
  15. 15.
    Kenngott HG, Fischer L, Nickel F, Rom J, Rassweiler J, Muller-Stich BP. Status of robotic assistance–a less traumatic and more accurate minimally invasive surgery? Langenbecks Arch Surg. 2012;397(3):333–41. PubMed PMID: 22038293.PubMedCrossRefGoogle Scholar
  16. 16.
    Baek SJ, Kim SH, Cho JS, Shin JW, Kim J. Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg. 2012;36(11):2722–9. PubMed PMID: 22855217.PubMedCrossRefGoogle Scholar
  17. 17.
    Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, et al. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19(12):3727–36. PubMed PMID: 22752371.PubMedCrossRefGoogle Scholar
  18. 18.
    Magistro C, Lernia SD, Ferrari G, Zullino A, Mazzola M, De Martini P, et al. Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc. 2013;9. PubMed PMID: 23397503.Google Scholar
  19. 19.
    Baik SH. Robotic colorectal surgery. Yonsei Med J. 2008;49(6):891–6. PubMed PMID: 19108010; Pubmed Central PMCID: 2628019.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP. Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg. 2012;99(9):1219–26. PubMed PMID: 22864881.PubMedCrossRefGoogle Scholar
  21. 21.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc. 2012;26(1):1–11. PubMed PMID: 21858568.PubMedCrossRefGoogle Scholar
  22. 22.
    Baik SH, Kim NK, Lee KY, Sohn SK, Cho CH, Kim MJ, et al. Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol. 2008;15(3):721–8. PubMed PMID: 18058183.PubMedCrossRefGoogle Scholar
  23. 23.
    Champagne BJ, Makhija R. Minimally invasive surgery for rectal cancer: are we there yet? World J Gastroenterol. 2011;17(7):862–6. PubMed PMID: 21412496; Pubmed Central PMCID: 3051137.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005; 365(9472):1718–26. PubMed PMID: 15894098.PubMedCrossRefGoogle Scholar
  25. 25.
    Ng KH, Ng DC, Cheung HY, Wong JC, Yau KK, Chung CC, et al. Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg. 2009;249(1):82–6. PubMed PMID: 19106680.PubMedCrossRefGoogle Scholar
  26. 26.
    Hellan M, Stein H, Pigazzi A. Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. Surg Endosc. 2009;23(2):447–51. PubMed PMID: 19057962.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Mehraneh Dorna Jafari
    • 1
    Email author
  • David E. Rivadeneira
    • 3
  • Alessio Pigazzi
    • 2
  1. 1.Department of SurgeryUniversity of California, Irvine School of MedicineOrangeUSA
  2. 2.Colorectal Surgery, University of CaliforniaIrvine Medical CenterOrangeUSA
  3. 3.North Shore-LIJ Health SystemHuntington Hospital, Hofstra University School of MedicineHuntingtonUSA

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