Revisiting the lateral-to-medial approach in robotic surgery for left-sided colorectal cancer

Robotic surgery has been widely adopted for left-sided colorectal cancer; however, mesenteric mobilization is predominantly performed using the medial-to-lateral approach. This technique can be technically demanding because dissection must be performed within a narrow working space dorsal to the mesenteric vessels, requiring the identification and preservation of the ureter and gonadal vessels. In robotic surgery, arm rigidity and the lack of tactile feedback may increase the risk of inadvertent pressure on the deep retroperitoneal structures. To address these challenges, we describe a lateral-to-medial approach that is optimized for robotic surgery. By utilizing wristed instruments, high-definition three-dimensional visualization, and stable traction, this approach enables mesenteric mobilization in a wider working space. In 19 patients, the mobilization time was comparable to that in the conventional approach, with no unintended deviation of the dissection plane. These findings suggest that the robotic lateral-to-medial approach is technically feasible and may be a useful option for robotic left-sided colorectal resection.