Robotic Single-Port Trans-stomal Hartmann Reversal
Antonino Spinelli1,2, Matteo Sacchi2, Ahmed M Chaoui2
1Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Background:
The colostomy site provides natural access for a single-port Hartmann reversal, making it an ideal scar-sparing procedure. Although single-incision laparoscopic surgery for this purpose is technically challenging, the da Vinci SP robotic platform may overcome single-incision laparoscopic surgery limitations: its wristed instruments and 3-dimesional visualization could enhance the feasibility of a full single-port approach.
Impact Of Innovation:
The robotic single-port approach for Hartmann reversal retains all the advantages of a single-port access through the stoma site while overcoming the technical limitations of single-incision laparoscopic surgery. The single-port approach minimizes tissue trauma, facilitates access to the left hemiabdomen, and restricts adhesiolysis to targeted areas only.
Technology, Materials, And Methods:
A peristomal incision was made to mobilize the colonic stump. After placing the anvil of a 31-mm circular stapler, the single-port robot was docked. Mobilization of the descending colon, splenic flexure, and rectal stump was performed to achieve a tension-free anastomosis.
Preliminary Results:
This report details 5 patients (3 women, 2 men), with a mean age of 57 years (range 46-70) and a mean BMI of 28.8 (range 16-44). The mean operating time was 199 minutes (range 140-290). The operations were completed without additional port placement. No intraoperative or major postoperative complications occurred. The mean hospital stay was 4 days (3-8).
Conclusions And Future Directions:
A fully robotic single-port Hartmann reversal is a feasible and safe option for bowel continuity restoration. This approach minimizes adhesiolysis, reducing tissue trauma and enteric injury risk. The single-port robotic platform enhances visualization and instrument control, overcoming the ergonomic and technical limitations of single-incision laparoscopic surgery. Future integration of advanced devices into the robotic single-port system will likely broaden its use in complex colorectal reconstructions. See New Technology Video.