Introduction: Robotic surgery is gaining in popularity but still has some significant drawbacks and hurdles. The robot is excellent for looking back at itself, towards one or two quadrants of the abdomen, but can not look in the opposite quadrant very well. That limits the robot's ability to perform procedures requiring multiquadrant procedures such as a total colectomy or total proctocolectomy. However, we have devised a method for overcoming this limitation and demonstrate it in this video.

Methods: We used the standard 3 arm version of the Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA). This includes one camera arm and two instrument arms. An additional accessory port was used by the bedside assistant. In order to overcome the limitations of the robot, we placed all robotic ports on the midline with the camera at the umbilicus. After completing takedown of one side of the colon, the robot was undocked, the patient's bed rotated 180 degrees, and the robot redocked to the same ports.

Results: No complications occurred. Operative time was 6 hours.

Conclusion: Multiquadrant surgery can be accomplished with the Da Vinci surgical robot but creativity may be required to overcome the machines drawbacks. Large numbers compiled being several institutions are required to fully assess the feasibility of the robot for these types of operations.