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Robotic surgery has emerged as the third platform that can be used by a colorectal surgeon to perform various resections. Like most new technologies, robotic surgery has had its share of critics and advocates. There are many commercial robotics forms available to colorectal surgeons worldwide. However, the authors’ experience is limited to the da Vinci platform and currently, we use the Xi version of the da Vinci robot for most rectal cases including rectopexy and proctectomies. Several surgeons advocate using the robot for all colorectal surgeries including right colectomies. However, in our practice, we still perform the right colectomies laparoscopically partly because it allows us to train the future generation in both laparoscopic and robotic techniques and partly because the biggest advantage of using the robotic platform is in the pelvis where the feet are narrow and further robotic surgery offers certain advantages over both laparoscopic and open surgery in our opinion. For the purpose of this chapter, the robotic platform being discussed will be limited to the da Vinci platform and largely the Xi version.
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ADVANTAGES OF ROBOTIC SURGERY
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The surgeon can control three arms. This takes away the dependence on a skilled assistant, especially in a narrow-working field such as the pelvis. This makes the platform more stable as the surgeon controls the camera and two working ports at all times.
Three-dimensional vision enhances the appreciation of tissue planes and has the potential to minimize injuries to structures such as nerves and blood vessels, especially in the narrow male pelvis.
The robotic instruments have increased the range of motion even when compared to the human hand. This gives the surgeon the ability to perform complex maneuvers within a very narrow space, allowing precise dissection in the pelvis.
Ability to switch the field of vision from 30 down to 30 up and vice versa without any physical movement of the camera. The authors have found this feature of the robotic platform to be very helpful during ultra-low dissection of the rectum and rectal transection during proctectomy.
The robotic platform is ergonomically superior to laparoscopy and open surgery as the surgeon can perform the surgery well seated and does not need to be scrubbed for it.
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DISADVANTAGES OF THE ROBOTIC PLATFORM
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Lack of tactile/haptic feedback. This is an important limitation of the current robotic platform and can potentially lead to tissue injury if the surgeon is not careful and does not follow visual cues in order to adjust the amount of traction being placed on the tissue.
Narrow field of vision. Compared to the laparoscopic platform, the robotic surgery field of vision tends to be narrower because the camera functions best when it is closer to the operative field. This restricts the “peripheral vision” of the operating surgeon and can lead to unsafe situations especially if the surgeon is not aware of the third arm ...