Robotic Left Colectomy with CME

Complete mesocolic excision (CME) was introduced by Hohenberger and it is well standardized for right colonic cancer as well as for cancers of the descending colon and sigma. However, for tumors of distal transverse colon, splenic flexure, and proximal descending colon, the CME remains less homogeneous. This is probably due to the complex anatomy around the splenic flexure, subject to many vascular and lymphatic variations. Different procedures have been described for the treatment of cancers located in distal transverse colon, splenic flexure, and proximal descending colon, confirming that surgical treatment is far from being fully standardized. Moreover, the complex identification of middle and left colic vessels and the subsequent lymph node dissection, as well as the intracorporeal anastomosis, represent the major technical difficulties to deal with these procedures with a safe minimally invasive approach. The robotic platform is gaining popularity in colorectal surgery and could potentially overcome the technical limitations of standard laparoscopy especially in vascular dissection, such as in segmental colonic resections, requiring central vascular ligation and in fashioning an intracorporeal anastomosis. Hereby, we present our technique of robotic CME splenic flexure resection and left colectomy, associated with central vascular ligation (CVL) and CME.