Robotic Transanal Minimally Invasive Surgery With da Vinci Single-Port Platform and Single-Port Access Port.

Background: The da Vinci single-port system has been used for transanal minimally invasive surgery, but there are limitations in accessing the distal rectum with the single-port system and traditional transanal access platforms. We present our case series using the single-port access port, which may provide more flexibility than traditional transanal access modalities.

Impact of innovation: This is, to our knowledge, the largest series presented of single-port transanal minimally invasive surgery using the access port as the transanal access platform. The access port provided safe and effective access to the anal canal, the entirety of the rectum, and even the distal sigmoid colon.

Technology, materials, and methods: We reviewed data for all patients who underwent transanal minimally invasive surgery using the da Vinci single-port system with the access port performed by a single surgeon. The primary outcomes analyzed included the success of the procedure without conversion to another method, intraoperative complications, and postoperative complications. We additionally analyzed tumor location from the verge, tumor pathology, and margin status.

Preliminary results: Seventeen patients underwent single-port transanal minimally invasive surgery using the access port between March 2023 and May 2024. All procedures had technical success, defined as the completion of the transanal minimally invasive surgery using the da Vinci single-port system without conversion to another method. No patient experienced intraoperative complications. We found the access port allowed us to access a range of lesions in terms of location in the rectum from the anal verge up to 22 cm proximally.

Conclusions and future directions: Robotic transanal minimally invasive surgery with the single-port system using the access port is safe, technically feasible, and allows a wide variety of lesions to be addressed both with full and partial-thickness resection. Further studies may additionally show improvements in patient comfort due to reduced trauma to the anus from the soft, flexible ringed access system.