Single-port robotic-assisted colorectal surgery using the da vinci SP system: a preliminary non-comparative exploratory cohort study

Background: Minimally invasive surgery, particularly robotic-assisted platforms like the da Vinci systems, has revolutionized colorectal surgery by improving precision and recovery. The novel da Vinci Single-Port (SP) system enables procedures through a single incision, offering potential advantages over multiport systems. Following its 2023 clinical authorization in China via Hainan’s special policy, this study evaluates the application of SP system in colorectal surgery within the Chinese population. Objective: To assess the perioperative safety, feasibility, and short-term oncological outcomes of the da Vinci SP system for diverse colorectal procedures. Methods: A preliminary non-comparative exploratory study (NCT********) enrolled 15 patients who received SP colorectal surgery from Oct. 2023 to Jul. 2024. Procedures included transanal endoscopic microsurgery (TEM), proctectomy, hemicolectomy, sigmoidectomy, and total colectomy. Primary endpoint: intraoperative conversion rate. Secondary endpoints: Clavien-Dindo ≥III complications within 30 days. Data collected: operative time (OT), blood loss (EBL), length of stay (LOS), pain scores (VAS), complications, resection margins, lymph node yield, and 12-month recurrence/mortality. Results: All 15 procedures (53.3% male; 46.7% prior abdominal surgery) were completed without conversion. Median OT: 119 min (transabdominal: 129 min; TEM: 89 min). Median EBL: 10 mL (transabdominal: 20 mL; TEM: 3 mL). Median LOS: 12 days (transabdominal: 14 days; TEM: 4 days). VAS pain scores were low (Day 1: 3; Day 3: 2). Three Clavien-Dindo II complications occurred (2 anastomotic leaks, 1 infection; no ≥III events). All 12 malignancies achieved R0 resection; median lymph nodes harvested: 13.5. No recurrence, metastasis, or mortality at 12-month follow-up. Conclusions: The da Vinci SP system is feasible and safe for diverse colorectal procedures, demonstrating zero conversions, minimal blood loss, acceptable operative times, and favorable short-term oncological outcomes. Limitations include small sample size and prolonged LOS (attributed to logistical factors). Larger multicenter studies are needed to validate long-term efficacy and cost-effectiveness.