PortSmouth TAble Rotation Robotic technique for pan proctocolecotmy using DaVinci Si robotic system; P-STARR technique

Robotic surgery offers a more natural feel and dexterity, a stable optical system and a tridimensional view of the operating field. Because of these technical benefits, robotic surgery has been widely accepted as a standard of care for urological surgery. However, the uptake of robotic colorectal surgery remains limited because of some inherent technical issues related to the setup and access of the target organs including challenges when operating in multiple quadrants of the abdomen.

The setup in robotic surgery is relatively fixed as compared to laparoscopic surgery. This rigid configuration of the robotic arms gives an excellent view of a target organ but is confined to a single abdominal quadrant. However, any access beyond the limits of a focused quadrant requires rearrangement of the robotic arms to complete the procedure effectively. This issue has been addressed for robotic rectal cancer surgery in several ways [1, 2]. However, not much has been written on robotic assisted colon surgery.

One of the main challenges when considering a robotic surgical approach for proctocolectomy is achieving an optimal docking to access a large target organ in all four quadrants and the pelvis. A single docking of the robotic cart between the legs has previously been described [3]. Whilst that method may work well in selected cases, it limits access to the rectum. Similarly, a double docking requires extra time for complete reconfiguration of the robotic cart and theatre equipment. We present a novel and simple technique of performing robotic proctocolectomy through a left sided docking (P-STARR technique).