How robotics is changing and will change the field of colorectal surgery

Abstract

During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci^® robotic system. The fourth generation da Vinci^® system, introduced in 2014, includes integrated table motion, intelligent laser targeted docking and more sophisticated instrumentation and imaging. These developments have enabled more surgeons to efficiently and safely perform multi-quadrant operations. Firefly^® technology allows assessment of colon perfusion and identification of ureters, and has shown potential in detecting occult recurrence or metastasis using molecular-labelled tumor markers. Wristed instrumentation has increased the technical ease of intracorporeal anastomosis (ICA) for many surgeons, leading to more common use of ICA during right colectomy. Advanced imaging has shown potential to decrease the incidence of presacral nerve injury and improve urogenital outcomes after pelvic surgery, as has been the case in robotic urologic procedures. Finally, the robotic platform lends itself to surgical simulation for surgical trainees, as a pre-operative tool for mock operations and as an ongoing assessment tool for established colorectal surgeons. Given these advantages, surgeons should anticipate continued and increased utilization of this beneficial technology.

Keywords: Colorectal; Infrared; Intracorporeal; Robotic; Simulation; Skills assessment.

Figure 1

Intraoperative picture of integrated fluorescence using near-infrared light to visualize tissue uptake of indocyanine green. A: Colon perfusion assessment after mesenteric vessel ligation, visualized with standard white light; B: Same area of colon assessed for perfusion after injection with indocyanine green, visualized with infrared light. Well-perfused tissue appears bright green. In both images, arrow points to area of demarcation. Above images obtained from Intuitive Surgical with permission for publication.