Single-port robotic restorative proctectomy with ileal pouch–anal anastomosis for ulcerative colitis - first clinical experience and technical insights

Sep 30, 2026

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Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the standard surgical option for ulcerative colitis (UC) patients aiming to avoid a permanent ileostomy, but its single-port (SP) robotic application remains insufficiently described. A single-center retrospective cohort reviewed UC patients undergoing SP robotic proctectomy with IPAA between October 2024 and June 2025. A standardized three-step approach using transanal transection single stapled (TTSS) anastomosis was performed. Feasibility was assessed by avoiding unplanned conversion, and safety by 30-day morbidity, readmission, and pouch leak rates.

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CategoryHealthcare

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Abstract

Introduction

Methods

Surgical technique

Techniques in Coloproctology (2026) 30:17 [https://doi.org/10.1007/s10151-025-03246-9](https://doi.org/10.1007/s10151-025-03246-9) Single‑port robotic restorative proctectomy with ileal pouch–anal anastomosis for ulcerative colitis: first clinical experience and technical insights Gabriele Bislenghi1 · Albert Wolthuis1 · André D’Hoore1 Received: 4 September 2025 / Accepted: 16 October 2025 © The Author(s) 2025 Abstract Background Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the standard surgical option for patients with ulcerative colitis (UC) wishing to avoid a permanent ileostomy. Single-port (SP) robotic surgery offers enhanced dexterity and visualization, potentially overcoming the limitations of single-port laparoscopy in the confined pelvic cavity. Its role in IPAA for UC is unexplored. Methods Patients with ulcerative colitis undergoing SP robotic proctectomy with IPAA at a tertiary center between October 2024 and June 2025 were reviewed. Procedures followed a standardized three-step approach with transanal transection single stapled (TTSS) anastomosis. Feasibility was defined as completion of the procedure without unplanned conversion to multiport laparoscopy, laparotomy, or transanal minimally invasive surgery (TAMIS) . Safety by 30-day postoperative morbidity, readmission, and pouch leak rates was analyzed. Results A total of 14 patients (median age 34 years; body mass index (BMI) 26.2 kg/m2) were included. Median operative time was 237 min (range 188–317 min) . Hospital stay was 5.8 days (range 3–12 days) . No conversions occurred; one case required the unplanned placement of additional 5-mm assistant trocar. Four patients (28.5%) developed postoperative complications. The mean Comprehensive Complication Index was 7.6 ± 12.8 (SD). Three patients (21.4%) required readmission within 30 days postoperatively. All patients underwent ileostomy closure at a median of 64 days after IPAA creation. Conclusions SP robotic proctectomy with IPAA is feasible and safe in unselected patients with UC, supporting further large prospective evaluation. Keywords Single port robotics · Ulcerative colitis · Ileal-pouch anal anastomosis Introduction Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) remains the standard surgical treatment for ulcerative colitis (UC) in patients requiring colectomy who wish to avoid a permanent ileostomy [1] . * Gabriele Bislenghi [gabriele.bislenghi@uzleuven.be](gabriele.bislenghi@uzleuven.be) Albert Wolthuis albert.wolthuis@uzleuven.be André D’Hoore [andre.dhoore@uzleuven.be](andre.dhoore@uzleuven.be) 1 Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium Over the past decades, the technique has undergone substantial evolution and refinement [2] . Recently, single-port (SP) robotic surgery has emerged, combining the benefits of single-port laparoscopy with those of robotic assistance—enhanced dexterity, three-dimensional visualization, tremor filtration, and improved ergonomics—allowing for greater precision and control, in particular during complex pelvic procedures [3] . Although SP robotic surgery has been evaluated in a limited number of colorectal cancer series [4], its role in inflammatory bowel disease (IBD), particularly in IPAA for UC, remain unexplored. The aim of this study is to present our first experience with SP robotic proctectomy with IPAA for UC, focusing on surgical technique, feasibility, and safety. Methods This was a single-center retrospective cohort study using data from a prospectively maintained pouch database at the University Hospitals Leuven, Belgium, a tertiary referral center for IBD. All patients undergoing SP robotic proctectomy with IPAA for UC as a second surgical step after previous minimally invasive total colectomy between October 2024 and June 2025 were identified. The study was conducted within the framework of the Crohn's

FAQs

What is the aim of using single-port robotic surgery for IPAA in ulcerative colitis?

The study aims to provide the first clinical experience with SP robotic proctectomy with IPAA for UC, focusing on surgical technique, feasibility, and safety.

How were feasibility and safety outcomes defined in this study?

Feasibility required completion without unplanned conversion to multiport laparoscopy, laparotomy, or TAMIS. Safety was evaluated using 30-day postoperative morbidity, readmission, and pouch leak rates.

What were the key results regarding conversion, complications, and readmission?

No conversions occurred; one case required an unplanned placement of an additional 5-mm assistant trocar. Four patients (28.5%) had postoperative complications, and three patients (21.4%) were readmitted within 30 days. All patients underwent ileostomy closure at a median of 64 days after IPAA creation.

Sep 30, 2026

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