N-Shaped Port Placement for Simultaneous Robot-Assisted Right and Left-Sided Colectomies

Minimally invasive surgery offers significant advantages, including smaller incisions, reduced postoperative pain, and shorter recovery, especially in surgeries requiring access to multiple abdominal quadrants. However, robot-assisted resection of synchronous colorectal cancer (sCRC) remains technically challenging and unstandardized due to its rarity. Herein, we propose an N-shaped configuration of five-trocar placement for the simultaneous right- and left-sided colectomies with intracorporeal anastomosis.

An 85-year-old woman with synchronous cecal (T1) and sigmoid colon (T3) cancers underwent simultaneous ileocecal resection and sigmoidectomy. A camera trocar at the umbilical incision and four additional trocars were arranged in an N-shaped configuration. The patient cart was docked from the left caudal side. Right-sided colectomy was performed first with intracorporeal anastomosis using robotic stapling. Following temporary undocking and a 180-degree boom rotation, the robotic sigmoidectomy was completed with a standard double-stapled anastomosis. Total operative time was 311 min with minimal blood loss, and the postoperative course was uneventful.

This N-shaped port configuration facilitated a seamless transition between right- and left-sided colectomies, maximizing the advantages of robotic surgery. Importantly, all tasks can be completed with this port configuration by a single patient-side surgeon. Although further studies are needed to evaluate the adaptability of this approach to other multiport robotic platforms, our experience suggests this technique is practical and effective for multiport robotic sCRC resections.