![]() ![]() The cart approaches the operative table from patient’s left hip ( ![]() Patient is placed in the reverse Trendelenburg position (15°), with a 30°-tilt to the right with the arms alongside the trunk and the legs abducted ( Robotic surgery has been introduced in colorectal surgery about 15 years ago, and it is spreading worldwide, thanks to its advantages over laparoscopic technique. Laparoscopic approach has been considered a challenging procedure, with longer operative time than in open surgery and a relative risk of splenic and pancreatic injuries, suggesting its use by expert surgeons and for early stage disease. Surgical technique for this kind of tumors is not standardized yet, because of anatomical aspects and technical issues. Pure transverse colon cancers are commonly defined as all those cancers occurring in the middle part of the transverse colon. Splenic flexure cancers are generally considered as all those cancers occurring between the distal part of the transverse colon and the proximal part of the descending colon. Laparoscopic approach to splenic flexure and transverse colon cancer, however, has not been investigated and it is still a matter of debate, mainly due to the rare incidence of the cancer of the left flexure, ranging approximately from 3 to 10% of all colon cancers, and to technical difficulties in approaching the transverse colon. All the main prospective trials comparing open and laparoscopic technique for colorectal cancer have shown same clinical and oncological outcomes of the two approaches. Since the 1990s, laparoscopic technique has become a standard approach for several surgical procedures in the field of colorectal surgery. Herein we discuss a standardized approach for robotic splenic flexure resection and transverse colon. In addition, robotic system can allow a better fashioning of the intracorporeal anastomosis, and the advent of fluorescence is useful to guide dissection and to evaluate the vascularization of the colon. Robotic technique has overcome some pitfalls of laparoscopy, thanks to its stability of vision, tremor filtering, and fine movements of the robotic arms that can help in better identifying and managing both vascular structures and side organs, thus avoiding splenic and pancreatic injuries. The relationship with the spleen and the absence of a consensus on the extent of surgery for splenic flexure cancer are two of several aspects that make splenic flexure surgery mostly debated. Laparoscopic approach to splenic flexure and transverse colon cancer, however, is still a matter of debate and considered challenging for both anatomical and technical aspects. 1, 2, 9, 13, 17 – 30Ģ0.Since the 1990s, laparoscopic technique has become a standard approach for several surgical procedures in the field of colorectal surgery. The arch between the right colic and the ileocolic arteries seems to be absent in approximately 6% of all cases. This anastomosis between the superior and inferior mesenteric arteries is absent in approximately 2% of all cases, and in a further 3% it is very small. Normally the anastomosis along the colon formed by different arches (marginal artery) is large enough to ensure a sufficient collateral circulation (anastomosis of Riolan). if accessory branches from the inferior mesenteric artery are present, arteries supply the transverse colon up to the right colic flexure. Accessory middle colic arteries have been described as branches of the gastroduodenal or left gastroepiploic arteries. Accessory middle colic arteries are of clinical importance, since in such cases the arterial blood supply of the colon by the superior mesenteric artery is extended to the left colic flexure or even as far as the descending colon. 1 – 16 The ileocolic artery is the most variable of the colic branches from the superior mesenteric artery. The gastroduodenal arteries (see Chapter 14 and 17), the jejunal, and ileal arteries are not depicted, but the arteries supplying the colon, cecum, and appendix are outlined in detail. 20 Superior Mesenteric Artery and Colic Arteries ![]()
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