Single-Port Robotic Cytoreductive Surgery for Colon Cancer Peritoneal Recurrence with the da Vinci SP.

Abstract

Robotic surgical platforms have demonstrated functional advantages in complex abdominal surgeries.^1-6 However, they are rarely employed in cytoreductive surgery (CRS).^7,8 The da Vinci SP platform may overcome the limitations of multi-port approaches with encouraging postoperative outcomes.^9-12 We present a case of peritoneal metastases from colon cancer, which was treated with neoadjuvant chemotherapy and CRS using the da Vinci SP system. A 61-year-old female patient with colon cancer exhibited ovarian and multiple peritoneal metastases 14 months after undergoing laparoscopic right hemicolectomy for colon cancer. The patient was referred to our institution for further management after bilateral salpingo-oophorectomy. After seven cycles of neoadjuvant chemotherapy, CRS was planned, including hysterectomy, rectal resection, left lower abdominal wall mass excision, greater omentectomy, cholecystectomy (gallbladder polyps), and hyperthermic intraperitoneal chemotherapy. The procedures were deemed feasible using the da Vinci SP system, and informed consent was obtained from the patient. A single port was introduced through a 4.5-cm umbilical incision. The peritoneal carcinomatosis index score was 7, and all procedures were completed, achieving complete cytoreduction (CC-0). The entire procedure lasted 501 min, with an estimated blood loss of 150 mL. The patient had a maximum pain numerical rating score of 3 and was discharged without complications on day 9. Adjuvant chemotherapy was administered, and the patient has remained recurrence-free for ≥ 6 months at the time of reporting. Single-port robotic CRS using the da Vinci SP appears feasible for highly selected cases with limited peritoneal metastases. This approach facilitates multi-quadrant dissection through a single incision, minimizes abdominal wall trauma, and potentially enhances postoperative recovery.