Robotic sigmoid colectomy and anterior resection with the novel procedure, the <scp>R</scp>obo<scp>L</scp>ap cooperative technique—a video vignette

Abstract

In robot-assisted surgery, it is essential to maximize the strengths of both surgical robots and laparoscopic devices [1-5]. Recently, we introduced in Colorectal Disease the RoboLap cooperative technique (RLT), a method combining robotic and laparoscopic surgery for the treatment of right-sided colon cancer [6] and transverse colon cancer [7]. In Video 1, we demonstrate the application of RLT for sigmoid and rectosigmoid cancer. As shown in the video, RLT can be employed at two critical stages of the operation. The first stage involves the dissection of the left colic artery (LCA) and inferior mesenteric vein (IMV) following ligation of the inferior mesenteric artery. The target direction of the dissection line of the sigmoid mesentery is grasped with the retraction arm, which forms the apex of a triangular configuration. The right and left edges of the peritoneum are grasped by the other two robotic arms. The mesentery is then dissected using the ultrasonically activated device (USAD), and the LCA/IMV are transected with laparoscopic clips. The second stage involves the dissection of the mesorectum just before rectal resection. The robotic retraction arm pulls and straightens the rectum, allowing the laparoscopic operator to perform mesorectal dissection using the USAD, with assistance from the other two robotic arms. This procedure allows the laparoscopic operator to safely and effectively utilize the USAD within a clear operative field created by the three robotic arms. This technique capitalizes on the advantages of both robotic and laparoscopic approaches and is particularly beneficial for the education of novice surgeons who may not yet be fully proficient with laparoscopic devices. Takehito Yamamoto: Conceptualization; writing – original draft. Meiki Fukuda: Conceptualization; methodology; writing – review and editing. Yoshiki Oshimo: Writing – review and editing. Yoshihisa Okuchi: Writing – review and editing. Kojiro Taura: Writing – review and editing; supervision. Hiroaki Terajima: Supervision; writing – review and editing. None. The authors declare no conflicts of interest. All the procedures were performed in accordance with the ethical standards of the Institutional Research Committee. Informed consent was obtained from all patients for educational and scientific purposes. Data sharing is not applicable to this article as no new data were created or analysed in this study.