First Report of a Hybrid Robotic Single-Port Extraperitoneal and Laparoscopic Transperitoneal Sigmoid Colectomy (SP-EXPERTS).

Abstract

The EXPERTS procedure offers an extraperitoneal anatomical reorientation for left-sided colorectal surgery, avoiding small-bowel interference and eliminating the need for steep Trendelenburg positioning. The integration of this approach with the single-port robotic platform may overcome ergonomic and technical limitations associated with both transperitoneal surgery and single-incision laparoscopy. To demonstrate the feasibility and technical steps of a robotic single-port EXPERTS procedure and highlight its potential advantages over conventional minimally invasive approaches. A female patient with a distal sigmoid tumor and no prior abdominal surgery underwent a robotic single port EXPERTS procedure at a tertiary colorectal center. The patient was positioned in Lloyd-Davis without Trendelenburg tilt. Retroperitoneal access was established via a left-flank incision, and the single port robotic system was docked for vascular control of the inferior mesenteric artery and vein and retroperitoneal mobilization of the left colon. Specimen extraction and intracorporeal anastomosis were completed transabdominally. The study followed the Declaration of Helsinki; informed consent for recording and dissemination was obtained. The EXPERTS approach was successfully completed using the single port platform with stable visualization, precise articulation in confined retroperitoneal planes, and avoidance of small-bowel interference or positional physiologic burden. Key anatomic structures including the ureter, gonadal vessels, and great vessels were clearly identified, and high-tie vascular ligation was achieved safely.