V55 - Right Colectomy, Refined: A Single-Port Robotic Approach

CME Eligible

Purpose/Background: The da Vinci Single Port robotic platform, approved by the FDA for intra-abdominal colorectal procedures in late 2024, introduces a novel method for performing complex minimally invasive surgery through a single incision. This video demonstrates a robotic right colectomy using the SP system via a Pfannenstiel incision which highlights key technical considerations, instrument setup, and advantages of this emerging approach. The goal is to showcase safe oncologic resection while minimizing incisional morbidity and optimizing cosmetic and postoperative outcomes.

Methods/Interventions: A 59-year-old female with a biopsy proven cecal adenocarcinoma and a BMI of 20 underwent a single-port robotic right colectomy. A 4 cm Pfannenstiel incision was made, and a wound protector with a bubble port was placed. A 12 mm assistant port was positioned in the left lower quadrant. The da Vinci SP robot was docked. Key steps included exposure of the ileocolic pedicle, high ligation with a central mesocolic dissection, mobilization of the right colon and hepatic flexure, and intracorporeal isoperistaltic ileocolic anastomosis. The specimen was extracted through the Pfannenstiel incision, which served as both the operative access and extraction site.

Results/Outcomes: The patient tolerated the procedure well with an uncomplicated postoperative recovery and discharge at 48 hours. Final pathology revealed pT3 pN0 disease with 47 lymph nodes harvested. The single-port robotic approach provided excellent visualization and ergonomics for a complete mesocolic excision with a proper oncologic resection. Cosmetic outcome and postoperative pain were favorable, and no additional incisions were required beyond the assistant port.

Conclusion/Discussion: The daVinci SP platform enables safe, oncologic right colectomy through a single Pfannenstiel incision, minimizing abdominal wall incisions. This approach offers multiquadrant access and direct visualization of the vessels, making it well suited for central mesocolic excision. Although limitations remain-including absence of a vessel sealer, suction-irrigator, and 8 mm stapler-requiring an assistant port, the SP system represents a promising evolution in minimally invasive colorectal surgery with potential benefits in pain reduction, cosmesis, and recovery.