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Introduction
Minimally invasive colectomy continues to evolve with the development of single-port robotic platforms designed to reduce abdominal wall trauma while preserving surgical precision. However, data on its broader implementation remain limited. We describe the operative technique and short-term postoperative outcomes of a single-port robotic right hemicolectomy.
Methods
The patient was placed supine in the lithotomy position and a 3-cm Pfannenstiel incision was created for placement of the single-port robotic access device. Using a medial-to-lateral approach, the cecum was elevated to expose the ileocolic vessels. The peritoneum overlying the ileocolic artery origin from the superior mesenteric artery was incised using electrocautery, and the ileocolic artery and vein were clipped and divided. Dissection proceeded in the retroperitoneal plane along the Toldt fascia with preservation of the ureter, duodenum, and pancreatic head. A mesenteric window was created to identify and divide the right colic vessels. The lateral attachments of the ascending colon and hepatic flexure were divided, completing the mobilization. A stapled side-to-side ileocolic anastomosis was constructed using a 60-mm robotic stapler, the mesenteric defect was closed, and the specimen was extracted through the Pfannenstiel incision. Fascial closure was performed with 0 PDS sutures, and the skin was closed in subcuticular fashion.
Results
Postoperatively, diet was advanced without nausea, vomiting, or abdominal pain. She ambulated independently, voided spontaneously, passed flatus, and had return of bowel function. Pain was effectively managed with multimodal non-narcotic therapy. Final pathology was reviewed and discussed with the patient. She was discharged home in stable condition on postoperative day two.
Conclusion
Single-port robotic right hemicolectomy was performed safely with an uncomplicated postoperative course and early discharge. These findings demonstrate the technical feasibility and short-term effectiveness of the single-port approach. Further studies with larger cohorts are warranted to evaluate its reproducibility and comparative outcomes on a broader scale.
A single-port right hemicolectomy was performed using a 3 cm Pfannenstiel incision for peritoneal access. Initial inspection revealed minimal omental adhesions to the anterior abdominal wall. The patient was positioned right-side up to facilitate small bowel displacement.
A medial-to-lateral approach was undertaken, beginning with identification of the ileocolic pedicle at its origin from the superior mesenteric artery (SMA). The peritoneum over the ileocolic vessels was incised and extended cranially toward the transverse mesocolon. The ileocolic artery and vein were dissected at their SMA origin, clipped, and divided.
Retroperitoneal dissection proceeded in the avascular plane along Toldt’s fascia, with careful identification and preservation of the ureter. The duodenum (C-loop) and pancreatic head were fully exposed and protected as the mesocolic plane was developed. Dissection continued superiorly until the hepatobiliary structures were encountered. A mesenteric window was then created to identify and divide the right colic vessels along the right side of the SMA.
Lateral mobilization of the ascending colon and terminal ileum was completed, connecting with the prior medial dissection and fully mobilizing the hepatic flexure. The omentum associated with the resection specimen was divided.
An intracorporeal side-to-side ileocolic anastomosis was constructed using a 60‑mm robotic stapler, followed by closure of the common enterotomy and mesenteric defect. The specimen was extracted via the Pfannenstiel incision, and the fascial defect was closed.
A 9.5 adenomatous polyp in the cecum was identified on a screening colonoscopy.
Hemodynamic instability / septic shock
Requires rapid open access and damage‑control surgery.
Diffuse peritonitis (e.g., perforated viscus, fecal contamination)
Uncorrected coagulopathy
Inability to tolerate pneumoperitoneum
Locally advanced or complex disease
Extensive intra‑abdominal adhesions
Bowel obstruction with marked distension
Morbid obesity
Surgeon and institutional factors
Single-port (SP) robotic da Vinci platform by Intuitive.
Supplements for SP robot by Intuitive.
Stapler for SP robot by Intuitive.
Flexible 3D articulating camera.
Two working instruments (e.g., fenestrated bipolar / Maryland dissector).
One energy device (e.g., monopolar scissors or advanced bipolar device).
Place the patient in a supine or lithotomy position with appropriate padding of pressure points.
Apply slight Trendelenburg with left tilt (≈10–15°) to facilitate gravitational displacement of the small bowel from the right colon. Use an access port (≈3–4 cm incision), commonly via Pfannenstiel or periumbilical site. Ensure proper orientation of the access port to permit 360° rotation and multi‑quadrant reach without redocking. Dock the SP robotic cart in alignment with the target anatomy (right colon), ensuring direct trajectory from the access port to the ileocolic pedicle. A bedside assistant is essential for suction, retraction, stapling (if not console-controlled), and suture management—consistent with SP workflow requirements. Consider optional assistant port if additional retraction, energy device use, or stapling access is required in selected cases.
Colonoscopy for tattooing the lesion and to exclude synchronous colonic lesions
CT scan thorax and abdomen to exclude liver and/or lung metastases.
This is performed as per the standard robotically assisted and laparoscopic procedural protocols.
Intraoperative or postoperative hemorrhage, particularly during central vascular ligation (ileocolic/SMA branches)
Ureter, duodenum, pancreas, or bowel injury during medial-to-lateral dissection
Leak, bleeding, or stricture at the ileocolic anastomosis
Surgical site infection or intra-abdominal abscess
Functional ileus or adhesive small bowel obstruction
Deep vein thrombosis or pulmonary embolism
Limited exposure and instrument crowding
Conversion to multi-port or open surgery
Increased risk during early learning phase
Need for additional port placement
Port-site complications
Infection, seroma, or hematoma
Incisional hernia (Pfannenstiel or umbilical site)
Wound-related pain or dehiscence
Inadequate lymph node harvest or margins (rare in experienced hands
None.
Lane T. A short history of robotic surgery. Ann R Coll Surg Engl 2018;100(6_sup):5–7; doi: 10.1308/rcsann.supp1.5.
2. Choi G-S, Kim HJ. Clinical applications of the da Vinci Single-Port robotic system for treatment of colorectal cancer: a narrative review. Ann Surg Treat Res 2026;110(1):35–46; doi: 10.4174/astr.2026.110.1.35.
3. Carbone F, Pace U, Di Marzo M, et al. Single-port versus multiport robotic colectomy for colonic neoplasia: short-term outcomes and learning-curve analysis. Surg Endosc 2026; doi: 10.1007/s00464-026-12948-6.
4. Borgas P, Shakir T, Francis N, et al. Single-port robotic colorectal surgery: a scoping review of outcome reporting and future directions for standardisation. J Robot Surg 2026;20(1); doi: 10.1007/s11701-026-03402-9.
5. Cho HJ, Kim WR. Early Single-Center Experience of DaVinci® Single-Port (SP) Robotic Surgery in Colorectal Patients. J Clin Med 2024;13(10); doi: 10.3390/jcm13102989.
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