Abstract Background Single-port (SP) robotic surgery represents the latest advancement in minimally invasive colorectal surgery, potentially addressing limitations of single-incision laparoscopy such as instrument crowding and loss of triangulation. Reports on its use in inflammatory bowel disease are lacking. The present study compared the short-term outcomes of SP robotic ileo-anal pouch (IPAA) for ulcerative colitis (UC) with conventional minimally invasive approaches. Methods A retrospective analysis of consecutive UC patients undergoing minimally invasive restorative proctectomy with IPAA after prior total colectomy at University Hospitals Leuven (February 2024–September 2025) was performed. Patients were grouped by surgical approach (SP robotic vs. laparoscopic/multi-port (MP) robotic). Postoperative outcomes included conversion to open surgery, operative time, 30-day morbidity (Comprehensive Complication Index CCI), Visual Analogue Scale (VAS) for postoperative pain, C-reactive protein (CRP) values, length of stay (LOS) and time to ileostomy closure. Continuous variables were compared using t-test or Mann-Whitney U test and categorical data by χ² or Fisher’s exact test with p 0.05 considered significant. Results Overall, 32 patients were included, with 16 in each group. Baseline characteristics were largely comparable, except for a higher body mass index (BMI) in the SP cohort (29 vs. 22 kg/m², p = 0.008) (Table 1). The SP group more frequently underwent a three-stage approach and uniformly received a total mesorectal excision (TME) with transanal transection and single-stapled (TTSS) anastomosis. No conversions to open surgery occurred. Operative time was significantly longer in the SP group (240 vs. 185.5 min, p = 0.007). The CCI was similar between groups (6 vs. 7.5, p = 0.342), and all anastomotic leaks (n = 3) occurred in the control cohort. Peak CRP levels (19 vs. 33 mg/L, p = 0.177), VAS pain scores, and time to first bowel movement were comparable between groups. Length of stay was significantly shorter in the SP group (5 vs. 9 days, p = 0.005). Readmission rates were similar (12.5% vs. 6.3%, p = 0.544). Among patients undergoing three-stage procedures, time to ileostomy closure did not differ between groups (66 vs. 77 days, p = 0.999) (Table 2). Conclusion Single-port robotic restorative proctectomy with IPAA appears feasible and safe, even in patients with higher BMI. Although operative time was longer, the low postoperative morbidity, the absence of anastomotic leaks with the TTSS technique, and shorter hospital stay suggest potential advantages over conventional minimally invasive approaches. References: Clavien, P.A., et al., The Comprehensive Complication Index (CCI(R)): Added Value and Clinical Perspectives 3 Years “Down the Line”. Ann Surg, 2017. 265(6): p. 1045-1050. Kim, S.J., B.J. Choi, and S.C. Lee, Overview of single-port laparoscopic surgery for colorectal cancers: past, present, and the future. World J Gastroenterol, 2014. 20(4): p. 997-1004. Marks, J.H., et al., A prospective phase II clinical trial/IDEAL Stage 2a series of single-port robotic colorectal surgery for abdominal and transanal cases. Colorectal Dis, 2023. 25(12): p. 2335-2345. Remzi, F.H., et al., Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care. Colorectal Dis, 2017. 19(11): p. 1003-1012. Conflict of interest: Dr. Cauwberghs, Brent: No conflict of interest Wolthuis, Albert: No conflict of interest D’Hoore, André Jan Louis: No conflict of interest Bislenghi, Gabriele: No conflict of interest
Cauwberghs et al. (Thu,) studied this question.