[Robotic procedures in the colorectal surgery]

PURPOSE

The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was developed specifically to compensate the technical limitations of laparoscopic instruments, such as two-dimensional vision, misalignment of hands and instruments, limited dexterity of instruments inside the patient, and fixed instrument tips. The da Vinci system provides a stable camera platform, three-dimensional imaging, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom.

METHODS

These advantages can be applied in the field of colorectal surgery, and that's why we are reporting 45 cases that underwent robotic colorectal surgery. We concluded that the da Vinci system may be useful in surgical procedures, such as splenic flexure takedown, dissection of the inferior mesenteric artery with identification of the nervous plexus, and dissection of a narrow pelvis. The major drawbacks of robotic systems are high cost, and a lack of tactile sensation and tensile feedback to the surgeon, who must depend on visual cues to estimate the tension exerted on tissue by the robotic arms.

RESULTS

In conclusion, robotic colorectal surgery can be performed safely and effectively, using the da Vinci surgical system, because this system has more dexterity and flexibility than conventional laparoscopic instruments. However, prospective randomized studies are necessary to evaluate the preservation of sexual and voiding function, as well as the oncological and functional (pelvic floor disorders) outcomes of this approach.

[An unusual contraindication for vascular reconstruction--case report]

The authors report on an unusual cause of interruption of a planned vascular operation. The authors detected an anomalous biliary duct at the beginning of the vascular reconstruction operation. This duct was situated between the peritoneum and the abdominal fascia, and was unintentionally opened during the operation. Thus the laparotomy wound was contaminated by bile. To prevent contamination of the vascular prosthesis, which was planned for the reconstruction (bifurcation prosthesis), the operation had to be interrupted.