Annals of Coloproctology

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Minimally invasive surgery

Expanding the boundaries of minimally invasive surgery: the feasibility of robotic natural orifice transluminal extraction colectomy and robotic no-incision colectomy in colorectal practice: Thalia Petropoulou, Kyriacos Evangelou, Andreas Polydorou; Ann Coloproctol. 2025;41(4):346-353. Published online August 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00647.0092

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Purpose
Minimally invasive surgery offers reduced trauma, accelerated recovery, and shorter hospital stays. Robotic technology further enhances laparoscopic precision, particularly in colorectal procedures. This study investigated the safety and effectiveness of robotic natural orifice transluminal extraction colectomy (R-NOTEC) and robotic no-incision colectomy (R-NIC), comparing these techniques to the conventional robotic colectomy.
Methods
Outcomes of patients undergoing robotic-assisted colorectal resection—either conventional robotic colectomy or R-NOTEC/R-NIC—using a single docking technique at a tertiary hospital over 3 years were analyzed. All patients were managed according to established Enhanced Recovery After Surgery protocols.
Results
In total, 100 patients were included, with 25 receiving R-NOTEC or R-NIC. The median age was 65 years (range, 30–82 years), and the median body mass index was 31.0 kg/m2 (range, 20.1–43.0 kg/m2). The median length of stay was significantly shorter in the R-NOTEC/R-NIC group than in the conventional robotic group (2.0 days vs. 3.4 days, P=0.021). Other outcomes, such as circumferential resection margin status, lymph node yield, and mortality, were similar between groups. The R-NOTEC/R-NIC group exhibited a slightly lower complication rate, as well as less opioid use. No conversions to open surgery occurred in either group.
Conclusion
R-NOTEC/R-NIC offer significant promise in colorectal surgery by minimizing trauma, expediting recovery, and maintaining oncologic safety. Nevertheless, these procedures require specialized surgical expertise and careful patient selection. Further research should focus on long-term outcomes and standardization of these techniques.

Citations

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Robotic-Assisted Surgery in Emergency General Surgery: A Prospective, Single-Center, Case Series
Thalia Petropoulou, Kyriacos Evangelou, Andreas Polydorou
Cureus.2025;[Epub] CrossRef

Minimally invasive surgery

Minimally invasive transanal excision for rectal tumors: technical feasibility compared to conventional approach: Ji Yeon Mun, Gyu Sung Geong, Nina Yoo, Hyung Jin Kim, Hyeon-Min Cho, Bong-Hyeon Kye; Ann Coloproctol. 2025;41(2):162-168. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00864.0123

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited.
Methods
Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups.
Results
There were no significant differences observed in patient’s demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation.
Conclusion
The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.

Citations

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Minimally invasive transanal excision over conventional transanal excision: pursuing the perfect removal of early rectal cancer
HyungJoo Baik
Annals of Coloproctology.2025; 41(2): 105. CrossRef

Minimally invasive surgery

Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study: Sung Uk Bae, Kyeong Eui Kim, Chang-Woo Kim, Ji-Hoon Kim, Woon Kyung Jeong, Yoon-Suk Lee, Seong Kyu Baek, Suk-Hwan Lee, Jun-Gi Kim; Ann Coloproctol. 2025;41(2):154-161. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00563.0080

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Abstract PDF

Purpose
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.

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Investigating the Efficacy of Layered Moderate Tension Reduction Suturing in Facial Aesthetic Surgery
Gui H Wang, Jin Y Gang, Yan Li
Cureus.2025;[Epub] CrossRef

Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess: Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek; Ann Coloproctol. 2016;32(3):105-110. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.105

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5 Web of Science
8 Citations

Abstract PDF

Purpose

Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port.

Methods

The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016.

Results

Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5–14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30–155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0–3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0–5 days) and 3 days (1–7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection.

Conclusion

Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.

Citations

Citations to this article as recorded by

Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef
Single-port laparoscopic appendectomy for perforated appendicitis using ArtiSential® wristed articulated instrument
Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimal Access Surgery.2023; 19(1): 168. CrossRef
Single incision laparoscopic appendectomy with surgical-glove port is cost-effective and reliable in complicated acute appendicitis: A casecontrol multicenter study in Colombia
Andrés Felipe Carrillo Montenegro, Sofía Aristizabal Rojas, Jean André Pulido Segura, Mauricio Pedraza, Laura Padilla, Ivan David Lozada-Martinez, Alexis Rafael Narvaez-Rojas, Luis Felipe Cabrera-Vargas
Heliyon.2023; 9(1): e12972. CrossRef
A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
Kyeong Eui Kim, In Soo Cho, Sung Uk Bae, Woon Kyung Jeong, Hyung Jin Kim, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2023; 26(2): 55. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
Single-incision Laparoscopy-assisted Appendectomy in the Pediatric Age Group: Our Experience
Hemanshi Shah, Charu Tiwari, Suraj Gandhi, Gursev Sandlas, Neha Sisodiya Shenoy
World Journal of Laparoscopic Surgery with DVD.2020; 13(2): 77. CrossRef
Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy
Masaaki Miyo, Shoichiro Urabe, Satoshi Hyuga, Tomo Nakagawa, Toshiya Michiura, Nobuyasu Hayashi, Kazuo Yamabe
Annals of Gastroenterological Surgery.2019; 3(5): 561. CrossRef
Minimally Invasive Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess
Ik Yong Kim
Annals of Coloproctology.2016; 32(3): 88. CrossRef

Reduced-Port Laparoscopic Surgery for a Tumor-Specific Mesorectal Excision in Patients With Colorectal Cancer: Initial Experience With 20 Consecutive Cases: Sung Uk Bae, Se Jin Baek, Byung Soh Min, Seung Hyuk Baik, Nam Kyu Kim, Hyuk Hur; Ann Coloproctol. 2015;31(1):16-22. Published online February 28, 2015; DOI: https://doi.org/10.3393/ac.2015.31.1.16

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30 Web of Science
26 Citations

Abstract PDF

Purpose

Single-port plus one-port, reduced-port laparoscopic surgery (RPLS) may decrease collisions between laparoscopic instruments and the camera in a narrow, bony, pelvic cavity while maintaining the cosmetic advantages of single-incision laparoscopic surgery. The aim of this study is to describe our initial experience with and to assess the feasibility and safety of RPLS for tumor-specific mesorectal excisions (TSMEs) in patients with colorectal cancer.

Methods

Between May 2010 and August 2012, RPLS for TSME was performed in 20 patients with colorectal cancer. A single port with four channels through an umbilical incision and an additional port in the right lower quadrant were used for RPLS.

Results

The median operation time was 231 minutes (range, 160-347 minutes), and the estimated blood loss was 100 mL (range, 50-500 mL). We transected the rectum with one laparoscopic stapler in 17 cases (85%). The median time to soft diet was 4 days (range, 3-6 days), and the length of hospital stay was 7 days (range, 5-45 days). The median total number of lymph nodes harvested was 16 (range, 7-36), and circumferential resection margin involvement was found in 1 case (5%). Seven patients (35%) developed postoperative complications, and no mortalities occurred within 30 days. During the median follow-up period of 20 months (range, 12-40 months), liver metastasis occurred in 1 patient 10 months after surgery, and local recurrence was nonexistent.

Conclusion

RPLS for TSME in patients with colorectal cancer is technically feasible and safe without compromising oncologic safety. However, further studies comparing RPLS with a conventional, laparoscopic low-anterior resection are needed to prove the advantages of the RPLS procedure.

Citations

Citations to this article as recorded by

Short-term outcomes of da Vinci SP versus Xi for rectal cancer surgery: a propensity score matching analysis of two tertiary center cohorts
Min Hyun Kim, Songsoo Yang, Yong Sik Yoon, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Surgical Endoscopy.2025; 39(1): 162. CrossRef
Efficacy and safety of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer
Zhi-min Liu, Qi-jun Yao, Fengyun Pei, Fang He, Yandong Zhao, Jun Huang
BMC Cancer.2025;[Epub] CrossRef
Robot‐Assisted Colectomy for Left‐Sided Colon Cancer: Comparison of da Vinci SP and Single‐Site Platforms
Kyeong Eui Kim, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
The International Journal of Medical Robotics and Computer Assisted Surgery.2025;[Epub] CrossRef
Comparison of surgical performance using articulated (ArtiSential®) and conventional instruments for colorectal laparoscopic surgery: A single‐centre, open, before‐and‐after, prospective study
Hye Rim Shin, Heung‐Kwon Oh, Hong‐min Ahn, Tae‐Gyun Lee, Mi Jeoung Choi, Min Hyeong Jo, Anuj Naresh Singhi, Duck‐Woo Kim, Sung‐Bum Kang
Colorectal Disease.2024; 26(12): 2092. CrossRef
Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef
Short-term outcomes of da Vinci SP versus Xi for colon cancer surgery: a propensity-score matching analysis of multicenter cohorts
Jin-Min Jung, Young Il Kim, Yong Sik Yoon, Songsoo Yang, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Journal of Robotic Surgery.2023; 17(6): 2911. CrossRef
Short-term and long-term outcomes of single-incision plus one-port laparoscopic surgery for colorectal cancer: a propensity-matched cohort study with conventional laparoscopic surgery
Mingyi Wu, Hao Wang, Xuehua Zhang, Jiaolong Shi, Xiaoliang Lan, Tingyu Mou, Yanan Wang
BMC Gastroenterology.2023;[Epub] CrossRef
Effects of Sevoflurane versus Propofol on Endogenous Nitric Oxide Metabolism during Laparoscopic Surgery
Ning Wang, Jing Zhang, Ruiling Zhao, Bin Zhao, Yongzhang Li, Xiaoqing Zhang, Peng Liu, Yang Gao
Journal of Healthcare Engineering.2021; 2021: 1. CrossRef
Reduced port versus open right hemicolectomy for colorectal cancer: a retrospective comparison study of two centers
Peter Tschann, Gerald Seitinger, Daniel Lechner, Stephanie Adler, Benedikt Feurstein, Paolo N. C. Girotti, Theresa Schmölzer, Philipp Szeverinski, Felix Aigner, Ingmar Königsrainer
International Journal of Colorectal Disease.2021; 36(7): 1469. CrossRef
Reduced-Port Robotic Right Colectomy with Intracorporeal Anastomosis for Right-Sided Colon Cancer Using the da Vinci Single-Site® Platform: A Pilot Case Series Study
Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Annals of Robotic and Innovative Surgery.2021; 2(2): 31. CrossRef
Short‐ And medium‐term outcomes of reduced‐port laparoscopic surgery in elderly patients with upper rectal cancer: A retrospective cohort study
Huawen Wu, Zhijian Zheng, Lewei Xu, Yingying Wu, Ziyi Guan, Wenhuan Li, Guofu Chen
Cancer Medicine.2020; 9(15): 5320. CrossRef
Laparoscopic resection of retroperitoneal paraganglioma behind the Spiegel lobe in a kyphotic patient: A rare case report
Hisataka Ogawa, Shin Nakahira, Tomoya Kishimoto, Kazuya Kato, Makoto Hasegawa, Keisuke Oyama, Takayuki Tou, Ryosuke Maki, Hoshi Himura, Hidemi Nishi, Nobuyoshi Ohhara, Jota Mikami, Yoichi Makari, Ken Nakata, Masaki Tsujie, Junya Fujita, Hiroki Ohzato
Asian Journal of Endoscopic Surgery.2019; 12(3): 344. CrossRef
A review of reports on single-incision laparoscopic surgery for Crohn’s disease
Kiyoshi Maeda, Hisashi Nagahara, Masatsune Shibutani, Tatsunari Fukuoka, Toru Inoue, Masaichi Ohira
Surgery Today.2019; 49(5): 361. CrossRef
Comparison of the short-term outcomes of reduced-port laparoscopic surgery and conventional multiport surgery in colon cancer: a propensity score matching analysis
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Annals of Surgical Treatment and Research.2018; 94(3): 147. CrossRef
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Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors
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Annals of Coloproctology.2018; 34(6): 322. CrossRef
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World Journal of Gastroenterology.2015; 21(45): 12970. CrossRef

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