Robotic Single-Port Trans-Stomal Proctectomy and Ileal-Pouch Anal Anastomosis Construction With Exoscope-Assisted Transanal Transection and Single-Stapled Anastomosis for Ulcerative Colitis.

Abstract

Background: Proctectomy with ileal pouch-anal anastomosis is a promising indication for the single-port approach, as the procedure can be performed using a single-port platform placed at the stoma site. A single-port robotic platform may address many of the challenges associated with single-incision laparoscopy. However, it lacks compatible stapling devices. Consequently, performing the distal rectal transection with linear laparoscopic staplers is suboptimal, as it often requires significant enlargement of the abdominal defect at the stoma site. The transanal transection and single-stapled anastomosis technique offers a practical solution, compensating for the absence of staplers while potentially providing additional benefits.

Impact of innovation: Integrating the single-port robotic platform with the transanal transection and single-stapled anastomosis technique may provide technical advantages for restorative rectal surgery through a minimally invasive, single-incision approach. This strategy eliminates the need for fascial enlargement, additional ports and staplers, potentially lowering procedural costs. The use of an exoscope enhances the visualization of the transanal phase and improves the potential for learning.

Technology materials and methods: A fully robotic single-port mesenteric lengthening and proctectomy were performed. The pouch was constructed through the stoma site, and the specimen retrieved transanally. An exoscope-assisted transanal transection and single-stapled anastomosis ileal pouch-anal anastomosis was performed.

Preliminary results: The video shows the technique in a 26-year-old male patient with ulcerative colitis. The operation was completed without additional ports placement. No intraoperative or postoperative complications occurred. The patient was discharged on postoperative day 4. The ileostomy was reversed after six weeks.

Conclusions and future directions: The fully robotic SP technique is feasible and safe in selected cases, particularly in centers with specialized expertise in ileal pouch-anal anastomosis surgery and robotic procedures. Its broader implementation will be further supported by the integration of advanced devices into the SP platform.