Int J Med Robot - Totally robotic single-position 'flip' arm technique for splenic flexure mobilizations and low anterior resections.

Tópicos

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Resumo

CKGROUND: Using the da Vinci robot in low anterior resection (LAR) has not been widely adopted due to limited range of motion of the robotic arms and the need to move the robot during operations. Our technique uses all three arms for both the splenic flexure and the pelvis, but with only one docking position.METHODS: The robot is placed to the left of the patient. The camera port is 3 cm to the right of the umbilicus. Arm 1 is placed in the RLQ. Arm 2 is placed midepigastric. Arm 3 is placed in the LLQ. Arm 3 starts off on the left side of the robot, on the same side as Arm 1 aimed cephalad. During mobilization of colon and splenic flexure, Arms 2 and 3 help retract the colon while Arm 1 dissects. Our pelvic dissection begins with Arm 3 "flipped" to the right side of the robot and redocked to the same left sided port aimed caudally. The robot does not need to be repositioned and the patient does not need to be moved. The pelvic dissection can now be done in the standard fashion.RESULTS: Our early experience includes four patients: two LARs and two left hemicolectomies. Mean operative time = 347 minutes, docking time = 20 minutes, and robotic surgical time = 195 minutes. Two complications occurred: post-operative ileus and high ostomy output. Mean LOS = 5.CONCLUSIONS: The robotic "flip" arm technique allows the surgeon to fully utilize all the robotic arms in LAR, which is unique versus other techniques.

Resumo Limpo

ckground use da vinci robot low anterior resect lar wide adopt due limit rang motion robot arm need move robot oper techniqu use three arm splenic flexur pelvi one dock positionmethod robot place left patient camera port cm right umbilicus arm place rlq arm place midepigastr arm place llq arm start left side robot side arm aim cephalad mobil colon splenic flexur arm help retract colon arm dissect pelvic dissect begin arm flip right side robot redock left side port aim caudal robot need reposit patient need move pelvic dissect can now done standard fashionresult earli experi includ four patient two lar two left hemicolectomi mean oper time minut dock time minut robot surgic time minut two complic occur postop ileus high ostomi output mean los conclus robot flip arm techniqu allow surgeon fulli util robot arm lar uniqu versus techniqu

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