Surgical technique in robotic right colonic resection. How we do it: operative steps and surgical video.

Minimally invasive surgery (MIS) has produced an important improvement in terms of peri-operative outcomes. Laparoscopic colorectal surgery presents comparable outcomes vs. open approach from an oncological standpoint. However, there are some technical challenges/hurdles that laparoscopy may have. Worldwide there are still too many colonic/rectal operations carried out by the open approach. The robotic technology may be useful in solving some of the potential laparoscopic issues and potentially it may increase the number of procedures performed in a minimally invasive way. This is a description of our standardized operative technique for Robotic Right Colonic Resection. Conceivably, this manuscript may be useful to collect more repeatable data in the future. Moreover, it might be a guide to learn the robotic technique and also for the expert surgeons as an additional tool which they may find useful during their teaching activity. In this manuscript, taking advantage of the long and extensive expertise in minimally invasive colorectal resections, connected to a robotic experience started by Giulianotti in October 2000, we present our standardized technique for the robotic right colonic resection. The currently available literature data have proven that robotic colorectal surgery is safe/feasible. From the literature data, and from our experience as well, we think that these are the following main points: 1) the right colectomy is often an operation which can be performed in a relatively simple way even with traditional laparoscopy. However, the robotic approach is easier to standardize and this operation is very useful from a teaching standpoint in order to master multiple robotic surgical skills (that can be applied in more complex colorectal operations); 2) the robotic surgery may increase the MIS penetrance in this field. 3) the robotic third arm (R3) is an important technical advantage which can potentially increase the range of surgical options available; 4) the robotic technology is relatively recent. Most of the available data are retrospective and there is literature heterogenity (this affects also the conclusions of the currently available meta-analysis results, which sometimes are conflicting); 5) we need more data from prospective randomized well-powered studies (with standardized technique). Achieving a standardized technical approach will be essential in robotic colorectal surgery.