Robotic Single-Port Trans-stomal Hartmann’s ReversalsRunning title: Robotic SP Hartmann’s reversal

BACKGROUND: The colostomy site provides natural access for a single-port (SP) Hartmann’s reversal, making it an ideal scar-sparing procedure. While single-incision laparoscopic surgery (SILS) for this purpose is technically challenging, the da Vinci SP® robotic platform may overcome SILS limitations: its wristed instruments and 3-dimesional visualization could enhance the feasibility of a full SP approach. IMPACT OF INNOVATION: The robotic SP approach for Hartmann’s reversal retains all the advantages of a SP access through the stoma site while overcoming the technical limitations of SILS. The SP approach minimizes tissue trauma, facilitates access to the left hemiabdomen, and restricts adhesiolysis to targeted areas only. TECHNOLOGY MATERIALS AND METHODS: A peristomal incision was made to mobilize the colonic stump. After placing the anvil of a 31-mm circular stapler, the SP robot was docked. Mobilization of the descending colon, splenic flexure and rectal stump were performed to achieve a tension-free anastomosis. PRELIMINARY RESULTS: This report details 5 patients (3 females, 2 males), mean age 57 years (46–70), mean BMI 28.8 (16–44). Mean operating time was 199 minutes (range 140–290). The operations were completed without additional ports placement. No intraoperative or major postoperative complications occurred. The mean hospital stay was 4 days (3–8). CONCLUSIONS AND FUTURE DIRECTIONS: A fully robotic SP Hartmann reversal is feasible and safe option for bowel continuity restoration. This approach minimizes adhesiolysis, reducing tissue trauma and enteric injury risk. The SP robotic platform enhances visualization and instrument control, overcoming ergonomic and technical limitations of SILS. Future integration of advanced devices into the robotic SP system will likely broaden its use in complex colorectal reconstructions. See New Technology Video .