EP555 - Feasibility of Single-Incision Robotic Colon and Rectal Surgery: A Single-Surgeon Experience Compared to a Texas Statewide Multicenter 46-Surgeon Group Practice

Purpose/Background: Robotic single-incision (SI) approach represents a relatively new and cosmetically appealing approach in minimally invasive colon and rectal surgery. While multiport robotic (MP) approach is well established, limited data exists comparing MP with SI colon and rectal resections regarding safety, efficacy and outcomes. We sought to evaluate perioperative outcomes between these two approaches using our group's large statewide dataset.

Methods/Interventions: We queried our practice's multicenter statewide deidentified database for robotic colon and rectal resection data from Q3 2021 through Q1 2025. Adult patients undergoing procedures with laparoscopic CPT codes (44204, 44205, 44206, 44207, 44208, 45395, 45402) were included. Patients were stratified by surgical approach: MP robotic versus SI robotic. Baseline demographics, operative characteristics, and outcomes were compared using Chi-squared, Fisher's exact, T-tests, and Mann-Whitney U tests, as appropriate. Binary logistic regression was performed on outcomes that were both clinically relevant and statistically significant. Two-sided p< 0.05 was considered significant.

Results/Outcomes: 6,270 patients fit our inclusion criteria, whereby 5,868 underwent MP robotic and 402 underwent SI approach. Baseline demographics were mostly similar, though SI patients had more comorbidities as evidenced by higher proportion of ASA III-IV (75.5% vs 66.6%, p=0.005) and more likely to undergo rectal resections (6.7% vs 3.9%, p< 0.001).

For SI patients, conversion to other approaches (open or hand-assisted) was considerably lower (0.2% vs 2.4%, p< 0.001) and mean intraoperative fluid administration was less (1350.5±570.9 vs 1539.5±834.2 mL, p< 0.001).

SI patients had a shorter median length of stay (2 vs 3 days, p< 0.001) and a lower incidence of ileus (0.2% vs 1.2%, p=0.044).

Complication rates were generally low and comparable between SI and MP, including surgical site infection (1.7% vs 1.5%, p=0.723) and anastomotic leak (0.5% vs 0.8%, p=0.397), respectively. Thirty-day outcomes (ER visits, readmissions, reoperations, and mortality) did not differ significantly.

On binary logistic regression, MP robotic approach independently predicted an inpatient stay of over two nights, with an adjusted odds ratio of 1.92 (1.53-2.42), p< 0.001. After adjustment, no significant relationship was found between approach and postoperative ileus.

Conclusion/Discussion: Robotic SI surgical approach is safe and demonstrated several advantages over MP robotic method, including lower conversion rates, reduced intraoperative fluid requirements, and shorter hospitalization while complication rates and outcomes were comparable. One limitation is that the SI resections were performed by one surgeon only, likely affecting the reproducibility of these findings. These suggest that SI approach is at least noninferior to established robotic approaches, with possible implications on decreased overall cost of care. Prospective analysis is needed to confirm these results and prove reproducibility.

Table 1. Baseline Characteristics by Surgical Approach
Demographics
Outcomes by Surgical Approach and Adjusted Odds Ratio for Length of Stay
Outcomes and Odds Ratios