Simultaneous Robotic Right Hemicolectomy and Partial Gastrectomy: Feasibility and Technique

Overview

This report presents a case of synchronous robotic right hemicolectomy and partial gastrectomy performed on a patient with concurrent colon and gastric cancers. The procedure demonstrated feasibility and safety using a standardized trocar placement and two docking phases with the Da Vinci Xi® system, optimizing operative efficiency and recovery.

Background

Approximately 4% of patients diagnosed with stomach cancer have synchronous colorectal cancer, necessitating combined surgical resections. Robotic minimally invasive techniques for right hemicolectomy and partial gastrectomy have been established since the early 2000s, but synchronous robotic resections remain rare. The robotic approach offers advantages in multi-organ resections, including improved postoperative recovery and procedural ease, which is particularly relevant during the COVID-19 pandemic to enhance safety for patients and healthcare workers. This case report aims to standardize and reproduce a technique for synchronous robotic resections of right colon and stomach malignancies.

Data Highlights

The patient was a 63-year-old man with BMI 30.5 and ASA score 2, diagnosed with ctT3N0 right colic flexure adenocarcinoma and early gastric antrum tumor. Pneumoperitoneum was induced at 14 mmHg. Four 8-mm robotic trocars and one 12-mm assistant trocar were placed along a defined line with 6.5 cm spacing. Two docking phases were performed: first for the right hemicolectomy in Trendelenburg position (25–30°) and second for the subtotal gastrectomy in reverse-Trendelenburg position (25°). Vascular ligations included ileocolic vessels, right branch of middle colic artery, pancreaticoduodenal and right gastroepiploic vessels, and left gastric artery. Lymphadenectomy encompassed D2 stations including 4sb, 4d, 6, 7, 8a, 9, and 12a.

Key Findings

• Robotic synchronous right hemicolectomy and partial gastrectomy are feasible and safe using the Da Vinci Xi® system with only two dockings.
• A standardized trocar placement along a single line optimized access to both sub-mesocolic and supra-mesocolic compartments.
• The procedure included complete vascular ligation and D2 lymphadenectomy tailored to both colon and gastric malignancies.
• Patient positioning was adjusted between phases to facilitate optimal surgical exposure: Trendelenburg for hemicolectomy and reverse-Trendelenburg for gastrectomy.
• The robotic approach may reduce postoperative recovery time and improve surgeon ergonomics, especially important during the COVID-19 pandemic.

Clinical Implications

This standardized robotic technique for synchronous right hemicolectomy and partial gastrectomy can be safely implemented in selected patients, potentially improving perioperative outcomes and recovery. The approach minimizes the need for multiple dockings and optimizes trocar placement, which may reduce operative time and complexity. Additionally, robotic surgery offers safety advantages during infectious outbreaks by minimizing staff exposure.

Conclusion

Simultaneous robotic resection of right colon and gastric malignancies is a viable minimally invasive option that can be standardized for reproducibility and safety. This technique holds promise for improving outcomes in complex multi-organ oncologic surgeries.

References

1. 1 -- Incidence of synchronous colorectal cancer in stomach cancer patients
2. 2 -- Feasibility of robotic right hemicolectomy (2002)
3. 3 -- Feasibility of robotic partial gastrectomy (2008)
4. 4,5,6 -- Laparoscopic synchronous resections case series
5. 7 -- Robotic synchronous resections case series
6. 8 -- Use of Intuitive Da Vinci Xi® system in complex oncologic surgery
7. 9 -- Optimization of trocar positioning for multi-compartment robotic surgery