Implementation of a single-port robotic platform into your colorectal surgery practice: a SAGES colorectal committee task force review of evolving robotic technology and innovations.

BACKGROUND: Robotic and endoscopic techniques continue to revolutionize minimally invasive surgery. Single-port (SP) robotic platforms mark a new era in minimally invasive colorectal surgery, combining single-incision/site access with full robotic articulation through a single access point. This manuscript, as a part of a four-part series, outlines specific technical considerations of the SP robotic platform including details of the platform, instrumentation, docking, and operative maneuvers.

METHODS: Subject matter experts from the SAGES Colorectal Committee SP Task Force performed a structured review of the currently FDA-approved SP robotic platform, assessing technical features, instrumentation, and workflow considerations for several key representative operations relevant to colorectal surgery. Three clinical areas of SP implementation included transanal robotic surgery, right colectomy, and low anterior resection (LAR). Task Force members (subject matter experts with early experience in SP robotic platforms) analyzed technical details, patient selection, and operative workflows. Representative procedural techniques were detailed with emphasis on instrumentation choice, docking strategies, and key operative steps specific to single-port colorectal surgery.

RESULTS: The technical aspects of the SP platform include full robotic articulation through a single 25 mm port. A SP approach also enables triangulation and dexterity within confined spaces using three wristed instruments and a flexible 3-D camera. The current 360-degree boom rotation facilitates multi-quadrant manipulation without redocking. Current limitations may include continued reliance on bedside assistance for certain energy and stapling operative steps, although stapling capability has expanded with FDA clearance of an SP-compatible 45 mm stapler as of April 2025. Training of the entire operative team and gradual progression of case complexity is recommended as the surgeon implements this new technology into clinical practice.

CONCLUSIONS: A SP robotic approach to minimally invasive colorectal surgical procedures is feasible for a range of colorectal surgery operations. In select procedures like SP TAMIS, SP right colectomy, and SP-LAR, the single-port platform appears to offer advantages related to reduced invasiveness and improved surgeon ergonomics compared to other minimally invasive approaches. Successful implementation requires structured training, careful patient selection, and adherence to evidence-based adoption principles.