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Operative Approach for Robotic Descending Colon Cancer Requiring Bidirectional Mobilization of the Splenic Flexure
Tsutomu Kumamoto1, Koki Otsuka2, Junichiro Hiro1
1Department of Surgery, Fujita Health University, Toyoake, Japan.
Asian Journal of Endoscopic Surgery
|July 20, 2026
Summary
Robotic surgery for descending colectomy may require splenic flexure and sigmoid-descending junction mobilization. An oblique-line port configuration optimizes the operative envelope and instrument access for these complex procedures.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robotic descending colectomy often necessitates mobilization of the splenic flexure (SF) and sigmoid-descending junction (SDJ).
- Bidirectional mobilization in multiport robotic surgery presents challenges, potentially limiting the operative envelope or causing arm interference with conventional port configurations.
Purpose of the Study:
- To describe port configurations for robotic descending colectomy requiring SF-SDJ mobilization.
- To evaluate the utility of oblique-line, curved-line, and stepped-line configurations using da Vinci Xi (DVXi) and da Vinci SP (DVSP) systems.
Main Methods:
- The study details the selection and application of DVXi port configurations (curved-line, stepped-line, oblique-line) based on lesion location and mobilization needs.
- The da Vinci SP (DVSP) system is presented as a complementary option.
- The oblique-line configuration involves arranging robotic ports diagonally from the liver's round ligament toward the lower abdominal midline.
Main Results:
- The oblique-line configuration effectively aligns camera and instruments with the mobilization direction.
- The DVSP system offers flexible access to both proximal and distal operative fields.
- These strategies facilitate stable robotic access without additional ports, redocking, or excessive instrument angulation.
Conclusions:
- The oblique-line configuration and DVSP system enhance operative access during robotic descending colectomy with SF-SDJ mobilization.
- These approaches improve surgical efficiency and reduce technical difficulties in complex robotic procedures.
