Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2019; 11(10): 381-387
Published online Oct 27, 2019. doi: 10.4240/wjgs.v11.i10.381
How robotics is changing and will change the field of colorectal surgery
Crystal Koerner, Seth Alan Rosen
Crystal Koerner, Department of Surgery, Emory University, Atlanta, GA 30322, United States
Seth Alan Rosen, Division of Colorectal Surgery, Emory University, Atlanta, GA 30322, United States
Author contributions: Rosen SA designed research; Koerner C and Rosen SA performed research; Koerner C and Rosen SA analyzed data; Koerner C and Rosen SA wrote the paper.
Conflict-of-interest statement: Rosen SA has been compensated in the past by Intuitive Surgical for giving lectures on robotic colorectal surgery.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seth Alan Rosen, MD, Assistant Professor, Division of Colorectal Surgery, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, United States. seth.rosen@emoryhealthcare.org
Telephone: +1-404-3753895 Fax: +1-678-4745444
Received: May 2, 2019
Peer-review started: May 5, 2019
First decision: August 2, 2019
Revised: September 4, 2019
Accepted: September 22, 2019
Article in press: September 22, 2019
Published online: October 27, 2019

During the last decade there has been a significant upward trend in colon and rectal minimally invasive surgery which can be attributed largely to the acceptance of robotic surgery platforms such as the da Vinci® robotic system. The fourth generation da Vinci® system, introduced in 2014, includes integrated table motion, intelligent laser targeted docking and more sophisticated instrumentation and imaging. These developments have enabled more surgeons to efficiently and safely perform multi-quadrant operations. Firefly® technology allows assessment of colon perfusion and identification of ureters, and has shown potential in detecting occult recurrence or metastasis using molecular-labelled tumor markers. Wristed instrumentation has increased the technical ease of intracorporeal anastomosis (ICA) for many surgeons, leading to more common use of ICA during right colectomy. Advanced imaging has shown potential to decrease the incidence of presacral nerve injury and improve urogenital outcomes after pelvic surgery, as has been the case in robotic urologic procedures. Finally, the robotic platform lends itself to surgical simulation for surgical trainees, as a pre-operative tool for mock operations and as an ongoing assessment tool for established colorectal surgeons. Given these advantages, surgeons should anticipate continued and increased utilization of this beneficial technology.

Keywords: Robotic, Colorectal, Infrared, Intracorporeal, Simulation, Skills assessment

Core tip: Firefly® technology is an integrated fluorescence capability that uses near-infrared light to visualize tissue uptake of indocyanine green, allowing for real-time, image-guided identification of key landmarks during surgical procedures. Wristed instrumentation, a feature of the da Vinci system, appears to enable more surgeons to perform advanced intracorporeal suturing, and thus intracorporeal anastomosis during right colectomy. Performing rectal surgery with a robotic platform may decrease risks of urogenital dysfunction compared to laparoscopic or open surgery. The robotic platform, through its master-slave configuration, digitalization of imaging, and software interface which can track kinetics, has enabled a revolution in surgical simulation.