Implementing single-port robotic platform into your colorectal surgery practice: a SAGES colorectal committee task...

Transanal surgery has advanced significantly since the introduction of transanal endoscopic microsurgery (TEM) in 1983. The single-port (SP) robotic system marks the latest technological advancement in minimally invasive transanal surgery, combining single-site access with full robotic articulation through a single 25 mm port. This is the first video dynamic manuscript and 2nd document of a four-part SAGES Colorectal Committee series outlining the foundational application of SP technology in colorectal surgery, specifically transanal minimally invasive surgery (SP-TAMIS).

The SAGES Colorectal Committee SP Task Force performed a structured review of the da Vinci SP system, assessing platform features, instrumentation, and workflow considerations for transanal surgery. Task force members (subject matter experts with early experience with single-port robotic platforms) analyzed technical details, patient selection, operative workflows, and early outcomes. Representative procedural video-based techniques were detailed with emphasis on instrumentation, docking, and key operative steps specific to the SP transanal procedure.

The SP platform appears to offer several technological advantages for transanal surgery: (1) natural hand-eye coordination in an inverted field, (2) enhanced visualization with an articulating cobra camera, and (3) a third arm for retraction and exposure. These features appear to improve precision, reduce collision risk and fatigue, and shorten operative time. Published early clinical data suggest low positive margin rates (≈ 4-5%) and acceptable morbidity for multiport robotic TAMIS/SP-TAMIS in selected patients. However, direct comparative evidence versus conventional TAMIS remains limited, and many comparisons are indirect across heterogeneous cohorts. Current limitations include high cost, limited distal reach, lack of dedicated energy devices, and learning curve. The learning curve appears to be shorter than for laparoscopic TAMIS. Peritoneal entry during full-thickness excision of upper rectal and anterior lesions is a recognized event in transanal surgery; the SP platform offers several features that may facilitate its management, though SP-specific incidence data are not yet available.

SME early experience with SP-TAMIS suggests that it can provide a safe, effective, and ergonomically superior method for local rectal excision. Mastery of this foundational application builds the skills needed for more complex SP colorectal procedures, with the potential for single-port robotics expansion into minimally invasive colorectal surgery through enhanced precision, reduced invasiveness, and improved surgeon ergonomics.