The following is a description of general technique for the robotic left and/or sigmoid colectomy. This particular technique is adapted for the DaVinci^® Xi robotic surgery platform. First, the patient is positioned in either supine or lithotomy position and secured to allow for steep right-tilt and reverse Trendelenburg [3, 4, 11, 19, 23]. Operating room setup and patient positioning is illustrated in Fig. 13.1.

Trocar placement for the sigmoid colectomy is seen in Fig 13.2a. This is similar to the set up for robotic LAR with some flexibility built in based on the need to mobilize more proximally or distally, depending on the location of the pathology. Traditionally, with the Si there was a need to have the ports at least 10 cm apart to avoid collisions, however with the Xi ports can be placed closer with less risk of collision. Additionally, ports are placed in a more linear arrangement for maximal access to the whole hemi-abdomen. Initial entry and pneumoperitoneum is usually obtained at the umbilicus by following the umbilical stalk under direct visualization. The lowest trocar in the right lower quadrant is 12 mm in size to allow for either a robotic or laparoscopic stapler. The rest of the robotic ports should be 8 mm in size. The left subcostal port may be moved more inferior laterally to accommodate for the ribs in the costal margin. If a laparoscopic assistant is available, then a 5 mm laparoscopic port can be placed in the upper right quadrant.

For a left colectomy, the trocar placement is similar to sigmoid colectomy except all the ports are placed midline or just off midline to avoid the falciform ligament (Fig. 13.2b). Once again the most inferior non-assistant port is 12 mm in size to allow for passage of the stapler.

The dissection can follow standard surgical approaches using either a medial to lateral or lateral to medial approach depending on the surgeon’s preference, the patient’s body habitus, or the disease process. The steps of these procedures are well described and our approaches are detailed below. The new integrated robotic energy device, stapler, and fluorescent imaging capabilities have proven most useful for performing colectomy.