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. 2025 Mar 12;40(1):63.
doi: 10.1007/s00384-025-04854-5.

Robotic proctocolectomy with ileal pouch-anal anastomosis: a hybrid approach

Pietro Calabrese  1   2 , Orsalia Mangana  3 , Carlo Alberto Manzo  4 , Laura Muirhead  3   5 , Valerio Celentano  3   5
Affiliations

Robotic proctocolectomy with ileal pouch-anal anastomosis: a hybrid approach

Pietro Calabrese et al. Int J Colorectal Dis. .

Abstract

Purpose: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the definitive surgical treatment for patients with ulcerative colitis or familial adenomatous polyposis. While laparoscopic surgery has been widely adopted, robotic surgery has emerged as a promising alternative, particularly for complex pelvic dissection. However, the robotic learning curve presents significant challenges. This study introduces a hybrid approach combining robotic and laparoscopic techniques to leverage the strengths of both, with a focus on the impact of the robotic learning curve and surgical training.

Methods: All patients undergoing hybrid or laparoscopic proctocolectomy with IPAA for ulcerative colitis between 2022 and 2024 were included. Data on patient characteristics and postoperative outcomes were collected prospectively. Primary outcomes were operating time and 30-day morbidity. All robotic procedures were performed by a consultant surgeon within their first 100 robotic cases.

Results: A total of 25 patients were included: 14 in the hybrid group and 11 in the laparoscopic group. The median operating time was 300 min for the hybrid approach versus 325 min for the laparoscopic approach. In the hybrid surgery group, between 72 and 90% of the laparoscopic part of the procedure was performed by a supervised surgical trainee.

Conclusions: The hybrid robotic-laparoscopic approach offers potential benefits over pure laparoscopy by reducing operative time and postoperative complications. Additionally, it provides a structured modular training opportunity, allowing surgeons to develop both laparoscopic and robotic skills, particularly during the early stages of their robotic learning curve.

Keywords: Hybrid approach; Ileal pouch-anal anastomosis (IPAA); Proctocolectomy; Robotic surgery.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Position of the operating trocars
Fig. 2
Fig. 2
Robotic proctectomy: therobotic camera is placed in trocar #3, while robot arms are connected to trocars #1, #2, and #4. Trocar #5 is used by the assistant
Fig. 3
Fig. 3
Laparoscopic left colectomy: thesurgeon is standing on the right side of the patient using operating trocars #1 and #3,while the assistant is retracting using trocar #4. The camera can be moved into trocar #2 or periumbilical.The reverseTrendelenburg position can facilitate this part of the procedure
Fig. 4
Fig. 4
Laparoscopic colectomy of the transverse and right colon: thesurgeon positions themselves between thepatient’s legs or to the left. Trocar #2 is designated for the laparoscopic camera, while trocars #1 and #3 are for operating instruments. The remaining trocars can be use by the assistant. If needed, the camera can be inserted into trocar #3, allowing the surgeon to choose the most appropriate and ergonomic operating trocars based on the patient’s anatomy
Fig. 5
Fig. 5
Final overview: trocar#3 is used for the protective ileostomy site
See this image and copyright information in PMC

References

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