Surgical management of the left colonic (splenic) flexure in the era of multiple robotic platforms: a narrative review
Year: 2026
Type: review
Abstract: Background: Carcinoma of the left colonic (splenic) flexure remains challenging because of its watershed vascular territory, marked arterial and lymphatic variability, and proximity to adjacent organs, making the optimal extent of resection controversial. The availability of multiple robotic platforms has further transformed the technological landscape of colorectal surgery. Methods: This narrative review integrates peer-reviewed evidence identified through PubMed/MEDLINE with the scientific content presented during the “Re.Live Experience” session of the 44th National Congress of the Italian Association of Hospital Surgeons (ACOI). The session included a comparison of robotic platforms, conventional laparoscopy, and three relive robotic resections. The manuscript followed a previously described artificial intelligence–assisted, clinician-supervised methodology. Results: Current evidence supports minimally invasive surgery and suggests that segmental colectomy is appropriate for selected splenic flexure cancers, with oncological outcomes comparable to more extended resections. However, the optimal extent of lymphadenectomy and the specific role of complete mesocolic excision and central vascular ligation remain incompletely defined. Given the variability of arterial supply and lymphatic drainage, accurate tumor localization and individualized preoperative vascular mapping are central to surgical planning. Robotic platforms differ in architecture, ergonomics, docking, and instrumentation, but current evidence does not establish the superiority of any specific platform. Conclusions: Successful splenic flexure surgery depends primarily on individualized anatomical and vascular planning, sound oncological principles, appropriate extent of resection, structured training, and procedural standardization rather than on the specific robotic platform used.
Authors: Alberto Molteni, Gianandrea Baldazzi, Maria Carmela Giuffrida, Pierenrico Marchesa, Antonello Mirabella, Michele Di Marino, Marco Caricato, Dario Maggioni, Irene Giusti, Giuliano Barugola, Piero Bazzi, Enrico Ciferri, Gianluca Di Mauro, Giovanna Ioia, Giulio Mari, Andrea Pisani Ceretti, Luigi Ricciardelli, Giuseppe Tirone, Luciana Pisano, Priscilla Cannone, Davide Telesco, Carla Vaccaro, Danilo Antona, Silvia Tedesco, Richard Sassun, Nicola Cillara, Manuela Cuoghi, ACOI and AI Collaborative Group
Institutions: Ospedale di Circolo di Busto Arsizio, Azienda Socio Sanitaria Territoriale della Valle Olona, Aziende Socio Sanitarie Territoriale Ovest Milanese, Azienda Sanitaria Locale di Asti, Ospedale Vincenzo Cervello, Ospedale Misericordia - Grosseto, Campus Bio Medico University Hospital, Azienda Ospedaliera di Desio e Vimercate, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Ospedale Sacro Cuore Don Calabria, Ente Ospedaliero Ospedali Galliera, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Azienda Sanitaria Locale Salerno, Ospedale Bassini, Aziende Socio Sanitarie Territoriale Nord Milano, Ospedale Santa Chiara, Provincia Autonoma di Trento, University of Milan, University of Pavia, "Celio" Military Hospital, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Santissima Trinità
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221583474