Single-port robotic total colectomy: technical standardisation and ergonomic considerations of suprapubic versus...

Single-port (SP) robotic platforms represent an evolution of minimally invasive colorectal surgery, enabling complex multi-quadrant procedures through a single incision. Evidence on SP robotic total colectomy (TC) remains limited, and technical standardisation is lacking. We describe a standardised SP robotic TC technique and report the technical/ergonomic considerations for two access configurations: suprapubic and periumbilical.

Three consecutive patients with Familial Adenomatous Polyposis underwent SP robotic TC with ileorectal anastomosis at a high-volume colorectal centre. Suprapubic access was used in one case, and periumbilical access in two. Operative steps, quadrant sequence, vascular approach, ergonomics and anastomotic strategy were systematically documented. Operative and short-term postoperative outcomes were analysed. A detailed surgical video accompanies the manuscript.

All procedures were completed robotically without conversion. Median operative time was 240 min, and median estimated blood loss was 50 ml. No intraoperative or 30-day postoperative complications occurred. The suprapubic access facilitated a bottom-up right colectomy but limited direct visualisation of left-sided central vessels, requiring a lateral-to-medial approach. Conversely, the periumbilical access provided a more central operative view, facilitating medial-to-lateral dissection of the left mesocolon and enabling a fully intracorporeal anastomosis.

SP robotic TC is feasible and safe in selected patients when performed by experienced colorectal robotic surgeons. Access configuration may influence exposure and dissection strategy, particularly for central vascular control and anastomotic planning. Standardised operative steps and awareness of platform-specific technical considerations may enhance reproducibility and support broader adoption of SP robotic TC.