Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer

Sep 29, 2026

Minimally invasive approaches for colorectal cancer aim to reduce postoperative pain and shorten recovery, yet rectal surgery remains technically demanding due to limited pelvic space and constrained instrument maneuverability. This technical note reports the feasibility and safety of a novel single-incision plus one robot-assisted surgery (SIPORS) approach for rectal cancer using the Hugo RAS system. Four cases treated between January and June 2025 received standardized setup, triangular port placement, and a combined robotic–assistant strategy for rectal transection and vessel control.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Technique

Ethics statement

Surgical technique

Technical Note Ann Coloproctol 2025;41(6):586-591 pISSN: 2287-9714 • eISSN: 2287-9722 [https://doi.org/10.3393/ac.2025.00787.0112](https://doi.org/10.3393/ac.2025.00787.0112) Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer Yu Yoshida, Yoshiro Itatani, Takehito Yamamoto, Ryosuke Okamura, Koya Hida, Kazutaka Obama Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan INTRODUCTION Minimally invasive surgery has become the standard approach for colorectal cancer treatment, offering advantages such as reduced postoperative pain, shorter hospital stays, and improved oncological outcomes [ 1]. Single-incision laparoscopic surgery was developed to further minimize surgical trauma by reducing the number of incisions. However, it poses technical challenges, including restricted tissue manipulation and instrument clashing. These difficulties are especially pronounced in rectal surgery, which requires precise dissection within a confined pelvic space [2, 3]. The introduction of surgical robots has overcome many of the limitations of conventional laparoscopy by providing enhanced dexterity and visualization. The da Vinci single port (SP) system (Intuitive Surgical) was specifically designed for single-incision use, allowing single-site procedures to be performed with robotic precision [4, 5]. Nonetheless, in rectal surgery, an additional assistant trocar (plus one port) is still required for colorectal transection because robotic staplers are not yet available for this application. The Hugo robot-assisted surgery (RAS) system (Medtronic) represents a new robotic platform with a modular design in which 4 robotic arms are mounted on individual carts. Although early clinical applications have shown encouraging results, its use in single-incision colorectal cancer surgery has not yet been report- ed. To our knowledge, this study provides the world’s first clinical experience with single-incision plus one robot-assisted surgery (SIPORS) using the Hugo RAS system for colorectal cancer. Here, we present our initial series of 4 cases, demonstrating the feasibility and safety of this novel approach. TECHNIQUE Ethics statement This study was approved by the Institutional Review Board of Kyoto University (No. 01891). All patients provided written informed consent for publication of the research details and clinical images. Surgical technique Patients with primary colorectal cancer who underwent SIPORS using the Hugo RAS system between January and June 2025 were analyzed. Under general anesthesia, patients were placed in the lithotomy position with their arms tucked. A vertical skin incision of approximately 4 cm was made at the umbilicus, after which a wound-protecting device and surgical glove were applied. Through this setup, one 11-mm camera trocar and two 8-mm robotic trocars were inserted to create a triangular configuration. Port placement and cart layout are shown in Fig. 1. A 12-mm assistant trocar Received: June 25, 2025; Revised: August 10, 2025; Accepted: September 4, 2025 Correspondence to: Yoshiro Itatani, MD, PhD, FACS Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan [Email: itatani@kuhp.kyoto-u.ac.jp](Email: itatani@kuhp.kyoto-u.ac.jp) 2025 Korean Society of Coloproctology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 586 [www.coloproctol.org](www.coloproctol.org) Ann Coloproctol 2025;41(6):586-591 Fig. 1. Port placement and surgical cart layout of single-incision plus one robot-assisted surgery (SIPO

FAQs

What problem does SIPORS aim to address in rectal cancer surgery?

SIPORS targets the technical limitations of conventional laparoscopy in rectal surgery, where precise dissection is required in a confined pelvic space with restricted tissue manipulation and instrument clashing.

Why is an additional assistant trocar still needed for rectal transection?

An assistant trocar is required because robotic staplers are not yet available for this specific application, so assistant tools are used for colorectal transection.

How are ports arranged in the described Hugo RAS SIPORS technique?

A vertical umbilical incision is made, followed by placement of one 11-mm camera trocar and two 8-mm robotic trocars to create a triangular configuration, with an additional right lower quadrant RLQ assistant trocar and a port-in-port setup for docking.

Sep 29, 2026

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