First Single-Incision Robotic Surgery Performed on Left Colon

Surgeons at George Washington University Hospital (GWUH; Washington DC, USA) performed the surgery using a single four-centimeter incision around the umbilicus. The surgeons used the DaVinci system, a product of Intuitive Surgical (Sunnyvale, CA, USA), to perform a medial to lateral approach with extra corporeal resection and anastomosis. At the beginning of the case, the robotic arms were crossed, and in the console the hand designations were switched so that the right and left hand controls were reversed, affording better control of the instrumentation.

While conventional laparoscopic surgery typically requires four incisions and a four-day hospital stay, single-incision robotic surgery involves less pain, fewer chances of postoperative problems--such as infection--and a shorter recovery period. The robot's three-dimensional (3D) view simulates normal vision, enabling the surgeon to see around structures more easily and avoid damaging the ureter, spleen, and major blood vessels. The robot also offers more stability, dexterity, and triangulation, allowing optimal manipulation of the tissue. The surgery was performed on August 22, 2011.

“With just one cut, a foot-long section of the patient's infected colon was removed through the belly button. Thirty-six hours after surgery, the patient was ready to go home,” said Vincent Obias, MD, director of the division of colon and rectal surgery at GWUH. “The left colon is technically more challenging for single-incision surgeries. Vital blood vessels and structures are situated close to the colon, requiring a high level of precision.”

A left hemicolectomy is designed to remove the descending colon, approximately half of the large intestine; it is necessary to remove such a large section of the bowel due to blood supply distribution, rather than considerations of disease extent. After removal of the diseased portion, the two free ends are joined in an anastomosis. Occasionally, if the sections are inflamed, it is necessary to create a temporary stoma to divert the bowel contents.

Related Links:
George Washington University Hospital
Intuitive Surgical