EPD204 - Early Experience with Single-Port Transabdominal Colorectal Surgery: Implementation and Outcomes from the Largest Reported Cohort

Purpose/Background: Single-port robotic systems represent the next evolution in minimally invasive colorectal surgery, with potential advantages in cosmesis, ergonomics, and recovery. While feasibility has been demonstrated in clinical trials, there is a lack of data on real life outcomes of this platform. This study describes the early implementation of a single-port robotic program for transabdominal and transanal colorectal surgery and reports outcomes from the largest single institution cohort to date.

Methods/Interventions: A database was maintained of all patients undergoing single-port colorectal surgery at a high-volume academic colorectal surgery practice. Data collected included patient demographics, operative characteristics (procedure type, operative time, conversion to multi-port/open), and postoperative outcomes (complications, length of stay, readmission, and anastomotic leak within 30 days). If applicable, pathologic variables were recorded for oncologic cases including T stage and number of lymph nodes harvested. Implementation outcomes, including feasibility (completion without conversion), and learning curve trends via operative and in-room time were assessed.

Results/Outcomes: A total of 40 patients underwent single-port colorectal surgery during the study period, of which 32 were transabdominal, representing the largest cohort reported to date. The most common procedures included sigmoid colectomy, low anterior resection, right hemicolectomy, transabdominal vaginoplasty, and 8 cases of transanal minimally invasive surgery (TAMIS). Feasibility was high, with 0 conversions to open or multi-port approaches. For similar cases, both mean operative times and mean in-room times improved over time. Postoperative recovery was favorable, with a mean length of stay of 4.5 days, and 30-day readmission/complication rates consistent with traditional multiport robotic approaches. For oncologic cases, adequate lymph node harvest (>12) and R0 resection was achieved in all cases.

Conclusion/Discussion: Single-port transabdominal colorectal surgery can be safely and effectively implemented in an academic colorectal practice. Early results from the largest cohort to date demonstrate excellent short-term outcomes and oncologic adequacy, with evidence of efficiency gains over time. These findings support broader evaluation of single-port technology as a standard option for minimally invasive colorectal surgery.