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ROBOTIC-ASSISTED SINGLE INCISION LAPAROSCOPIC COLORECTAL SURGERY USING A MULTI-PORT ROBOTIC SYSTEM IS SAFE AND FEASIBLE
Kaiser O. Sadiq
*, Ashley Alden, Jin Kim, Robert D. Bennett
University of South Florida Morsani College of Medicine, Tampa, FL
BackgroundSingle incision laparoscopic surgery (SILS) offers improved cosmesis and similar morbidity compared to conventional laparoscopic surgery. Adoption has been limited however due to technical challenges including sub-optimal ergonomics. There is no single port robotic system currently FDA-approved for colorectal indications. We present a case series of 11 consecutive patients at a single institution undergoing colorectal procedures using robotic-assisted SILS (rSILS) using a multiport platform.
MethodsrSILS was performed using a single incision, gelport abdominal access platform, and docking a multiport robotic system with standard robotic trocars placed through the gelport. For rSILS Hartmann’s reversals, the colostomy was taken down via a peristomal incision, and the gelport placed through the ostomy site. For other rSILS cases, the abdomen was accessed via a 3-4cm periumbilical incision. Robotic trocars were placed through the gelport sleeves and the robot was docked (Fig 1). Specimens were removed through the gelport wound protector.
ResultsPatient demographics are listed in Figure 2. Median age was 50 years (IQR 40–60) and BMI was 28 kg/m
2 (IQR 25–34). 27% (n=3) were male and 55% (n=6) had prior abdominal surgery. Procedures performed included Hartmann’s reversal (n=4), right hemicolectomy (n=3), sigmoid colectomy (n=1), ileocolic resection (n=2), and small bowel resection (n=1) (Figure 2). Intracorporeal anastomosis was performed in 73% of cases. Median operative time was 176 min (IQR 153–242) and estimated blood loss of 30 mL (IQR 23–75). No intraoperative complications occurred and no additional ports or conversion to laparoscopy or laparotomy was required. Median postoperative stay was 3 days (IQR 2–3). No 30-day mortalities or major morbidities (Clavien-Dindo < grade III) occurred.
DiscussionrSILS appears to be safe and feasible for a variety of colorectal procedures. SILS improves cosmetic outcomes and patient satisfaction with no detrimental impact on perioperative outcome. While there is a concern for a higher incisional hernia risk with a larger SILS incision, this is less relevant in CRS as an extraction site incision of 3-4cm for a large specimen is required regardless of approach.
ConclusionrSILS using a standard multiport robotic platform and gelport abdominal access device is safe and feasible in CRS. Patient selection is likely to be critical and this technique is likely to be more difficult in patients with higher BMI, low rectal anastomosis, or the need for splenic flexure mobilization.
Fig 1 (A and B) Gelport over umbilical incision with two 8 mm robotic sleeves (white arrows) and a 12 mm robotic sleeve (red arrow). (C and D) Multi-port robotic system docked with the robotic camera and fenestrated bipolar forceps inserted.
Fig 2 (A) Table of demographics, intraoperative details, and surgical outcomes of single-incision robotic-assisted laparoscopic colorectal surgery, (B) pie chart of underlying pathologies, and (C) pie chart of procedures performed.
*readmitted for hypertension
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