Single-port robotic colectomy: a literature review
Review Article

Single-port robotic colectomy: a literature review

Kaelen Kay ORCID logo, Jordan Fader ORCID logo, Alexandra Elias ORCID logo

Department of General Surgery, Kern Medical Center, Bakersfield, CA, USA

Contributions: (I) Conception and design: All authors; (II) Administrative support: A Elias; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Alexandra Elias, MD, FASCRS. Division of Colon & Rectal Surgery, Department of General Surgery, Kern Medical Center, 1700 Mount Vernon Avenue, Bakersfield, CA 93306, USA. Email: alexandra.elias@kernmedical.com.

Background and Objective: The first single-port laparoscopic right hemicolectomy was performed in 2008 at the Cleveland Clinic. In 2020, Marks and colleagues conducted the first single-port robot-assisted laparoscopic colectomy. The single-port technique involves inserting a single trocar through a 4–5 cm incision, with four trocar external ports. Recent studies reported benefits to single-port robotic colectomy over single-port laparoscopic and multi-port robotic and laparoscopic colectomy. These include reduced postoperative pain, shorter length of stay, lower costs, and improved cosmesis. Single-port robotic colectomy remains underutilized, potentially due to limited high-quality evidence supporting its safety and efficacy. This narrative with structured literature review aims to synthesize the literature published and underscores the need for further research to establish its patient benefit and clinical utility.

Methods: The literature was surveyed on PubMed and Cochrane Library for English-language peer-reviewed articles (up to October 30, 2025) documenting single-port minimally invasive surgery.

Key Content and Findings: Preliminary data from smaller studies included in this review suggest that single-port robotic colectomy is safe and feasible, but it presents new challenges not encountered in multiport robotic colectomies. Challenges reported in the literature include collisions and instrument trapping, longer docking and operational times, lack of retraction, and inadequate exposure. Additionally, the single-port robotic system does not yet include a vessel sealer, stapler, suction device, or advanced energy delivery device. Adoption of single-port robot-assisted laparoscopic surgery has been slow.

Conclusions: Limited data are available for comparison with laparoscopic and multi-port robotic techniques, which poses a challenge for drawing significant conclusions. More studies should be performed, on a larger scale, to achieve adequate statistical significance for this data. As it stands, single-port colectomies are not being performed frequently, likely due to ergonomic challenges, limited access to specific instruments, and limited exposure to the technique. If further research, namely randomized controlled trials (RCTs), demonstrates superiority and/or advantages over multi-port procedures, surgeons may attempt single-port colectomies more frequently.

Keywords: Olectomy; single-port; minimally invasive; robotic surgery; laparoscopic

Received: 31 October 2025; Accepted: 08 April 2026; Published online: 28 April 2026.

doi: 10.21037/ales-2025-1-56

Introduction

Background

The introduction of the single-port robotic system with wristed articulation and flexible elbows, a console-controlled camera, three-dimensional (3D) optics, and a holographic instrument positioning monitor constitutes a significant advancement in colorectal surgery. The first single-port laparoscopic right hemicolectomy was performed in 2008 by Geisler at the Cleveland Clinic. In 2020, Marks performed the first single-port robot-assisted laparoscopic colectomy (1). The single-port technique involves inserting a single trocar through a 4–5 cm incision, with 4 trocar external ports (2). This contrasts the multi-port system which utilizes 3–4 separate incisions for each instrument. It has been reported that the single-port robotic system offers greater ease of movement compared to laparoscopy and the multiport robotic approach, thanks to multi-jointed instruments that provide improved spatial orientation, collision prevention, and ease of use (1).

Rationale and knowledge gap

Few studies have directly compared single-port robotic colectomy with multi-port robotic colectomy or laparoscopic colectomy, and there are no published randomized controlled trials (RCTs) comparing single-port robotic colectomy with other methods. However, smaller studies have reported benefits of single-port robotic colectomy, including reduced postoperative pain, length of stay, and cost compared with laparoscopic colectomy (2,3). Pitfalls of single-port colectomies may include longer operative times due to inadequate exposure and the potential for instrument collision and entrapment, compared with traditional laparoscopy (2,4).

There is limited data available to conclude the efficacy and feasibility of single-port robotic colectomy relative to other techniques, such as multi-port robotic and laparoscopic colectomy.

Objective

This narrative review with a structured literature search aims to review and summarize the publications on single-port robotic colectomy. We present this article in accordance with the Narrative Review reporting checklist (available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-56/rc).

Methods

The literature was surveyed on PubMed and Cochrane Library for peer-reviewed articles documenting the single-port robotic technique. Search terms are as follows: “‘single-port robotic colectomy’ OR ‘robotic colectomy’ OR ‘single incision laparoscopic colectomy’ OR ‘robot-assisted laparoscopic colectomy’ OR ‘single incision colectomy’ OR ‘single incision robotic surgery’”. Inclusion criteria included: English language, peer-reviewed article, any location, any timeframe, and any published year. Exclusion criteria included articles in languages other than English for which no translation is available and articles in which colectomy and/or single port robotic (SPR) surgery was not discussed. Articles were also identified by reviewing the above-listed databases for publications that cited previously identified seed articles. All identified articles were reviewed, and data were collected from each. These results are depicted in Table 1. Search methods are outlined in Figure 1, and the search strategy summary is depicted in Table 2.

Table 1

Results extrapolated from the studies included in the literature review with study type, surgery method (SPR vs. MPR vs. MPL), type of resection, and results reported

Article Study type Method Resection type (s) Total number of patients Indications Complication rate (%) LOS (days) Blood loss (mL) Mean operative time (minutes) Lymph node yield Incision size (cm)
Byrn et al. (24) Retrospective case series SPR vs. MPL SPR right [17], left [12]; MPL right [33], left [3] SPR 29; MPL 36 Colon cancer, Crohn’s disease, diverticulitis NR SPR 5.3; MPL 7.1 (P=0.20) SPR 121; MPL 164 (P=0.35) SPR 150, MPL 149 (P=0.92) SPR 18; MPL 20.1 (P=0.57) NR
Chang et al. (25) Retrospective cohort study SPR vs. MPR SPR right [6], left [1], sigmoid [13]; MPR right [4], left [2], sigmoid [14] SPR 20; MPR 20 Colon cancer SPR 5; MPR 5 (P>0.99) SPR 8.4; MPR 8.5 (P=0.20) SPR 10; MPR 25 (P=0.03) SPR 185.5; MPR 193.2 (P=0.45) SPR 19.6; MPR 22.5 (P=0.10) SPR 5.5; MPR 9.5 (P=0.04)
Cho et al. (3) Retrospective case series SPR LAR [3], right [2], AR [5] 10 Colon and rectal cancer 10 6 148 222 NR 3.3
Jung et al. (19) Retrospective cohort study SPR vs. MPR SPR right [21], left [9], AR [23]; MPR right [19], left [9], AR [25] SPR 53; MPR 53 Colon cancer SPR 7.5; MPR 13.2 (P= NR) SPR 5; MPR 6 (P=0.002) SPR 10; MPR 10 (P=0.33) SPR 150; MPR 153 (P=0.97) SPR 49 ; MPR 46 (P=0.52) SPR 5; MPR 9.4 (P=0.001)
Juo et al. (10) Retrospective case series SPR Right [31], sigmoid [20], left [5] 59 Diverticulitis, colon cancer, familial adenomatous polyposis, Crohn’s 27.1 4 100+/−90 188 27 4.0
Keller et al. (23) Retrospective cohort study SPR vs. SPL SPR right [6], left [5], TATA [32], LAR [6], APR [1]; SPL right [6], left [5], TATA [20], LAR [18], APR [1] SPR 50; SPL 50 Colon and rectal cancer SPR 0; SPL 3.8 (P=0.52) SPR 4.1; SPL 5.3 (P=0.002) SPR 150; SPL 170 (P=0.38) SPR 318; SPL 296 (P=0.06) NR NR
Kim et al. (11) Retrospective cohort study SPR LAR [16], sigmoid [15], right [15], left [4] 50 Colon and rectal cancer, diverticulitis, Crohn’s 12 7 203 272.5 18 6
Kim et al. (21) Retrospective cohort study SPR vs. MPL Right, left, transverse, AR, LAR SPR 43; MPL 97 Colon cancer SPR 16.3; MPL 20.6 (P=0.55) SPR 7.7; MPL 8.6 (P=0.06) SPR 60; MPL 71.3 (P=0.31) SPR 232; MPL 204 (P=0.001) SPR 22.1; MPL 10.7 (P=0.43) NR
Huang et al. (27) Retrospective cohort study SPR TEM [3], LAR [6], APR [1], sigmoidectomy [2], colectomy [1], right [2] 15 Colon and rectal cancer 20 12 10 119 13.5 NR
Kim et al. (12) Retrospective cohort study SPR AR 31 Colon and rectal cancer NR 6.3 27 233.5 17.4 4.1
Konstantinidis et al. (9) Case report SPR Right 1 Hematochezia secondary to a colon mass NR NR NR 221 26 2.5
Lim et al. (13) Retrospective cohort study SPR Right 41 Colon cancer 8 6 100 182 27 5
Marks et al. (20) Clinical trial SPR Left [22], LAR [12], procto [12], right [8], rectopexy [2], Hartmann’s reversal [1], TATA [30], APR [6] 93 Rectal and colon cancer, diverticulitis 1 4 50 357 24 4.5
Marks et al. (1) Retrospective case series SPR Left 2 Diverticulitis 0 2-3 <60 306 NR 4.25
Noh et al. (26) Retrospective case series SPR Right [5], LAR [1], AR [1] 7 Colon cancer, diverticulitis 28 7 50 300 17 3.75
Noh et al. (28) Retrospective cohort SPR vs. SPL Right [69]; LAR [112] 181: SPR [86], SPL [95] Colon cancer SPR 0, SPL 7 NR SPR 33.7, SPL 72.1 SPR 180.3, SPL181.3 SPR 21.4, SPL 24.9 SPR 4.7, SPL 4.6
Piozzi et al. (18) Retrospective case series SPR Right [5], transverse [1], intersphincteric [7] 13 Colon and rectal cancer 30 7 <50 278 27 3
Salem et al. (5) Prospective case series SPR Left 4 Diverticulitis 0 2–3 91 310 NR 4.4
Sarin et al. (16) Retrospective cohort study SPR vs. MPR Right 35: SPR [5], MRP [25] Colon cancer [2], appendiceal goblet cell carcinoma, appendiceal orifice adenocarcinoma [1], intermittent cecal volvulus [1] SPR 40; MPR 40 (P= NR) SPR 3; MPR NR (P= NR) SPR 50; MPR NR (P= NR) SPR 199, MPR NR (P= NR) NR NR
Song et al. (7) Prospective case series SPR Right 5 Colon cancer 20 7 20 160 41 4

APR, abdominoperineal resection; AR, anterior resection; LAR, low anterior resection; Left, left hemicolectomy; LOS, length of stay; MPL, multi-port laparoscopic; MPR, multi-port robotic; NR, not reported; Procto, proctosigmoidectomy; Right, right hemicolectomy; SPL, single-port laparoscopic; SPR, single-port robotic; TATA, transabdominal transanal; TEM, transanal endoscopic microsurgery.

Figure 1 Flow diagram detailing the search method for studies included in literature review.

Table 2

The search strategy summary

Items Specification
Date of search October 30, 2025
Databases and other sources searched PubMed, Cochrane
Search terms used “‘Single-port robotic colectomy’ OR ‘robotic colectomy’ OR ‘single incision laparoscopic colectomy’ OR ‘robot-assisted laparoscopic colectomy’ OR ‘single incision colectomy’ OR ‘single incision robotic surgery’”
Timeframe Prior to October 30, 2025
Inclusion and exclusion criteria Inclusion criteria: English language, peer-reviewed article, any location, any timeframe, and any published year; exclusion criteria: articles in languages other than English for which no translation is available and articles in which colectomy and/or single port robotic surgery was not discussed
Selection process Performed by K.K. and J.F., if consensus was not able to be obtained, A.E. would serve as tie-breaker; however, consensus was obtained by K.K. and J.F. for each study reviewed

N/A, not available.

Results

Preliminary data from smaller studies included in this review suggest that single-port robotic colectomy is safe and feasible. Still, it introduces unique challenges not seen in multiport procedures, such as instrument collisions, trapping, longer operation times, prolonged docking, limited retraction, and decreased exposure (1,4,5). Technological advancements in the single-port system address many of these issues, enhancing maneuverability and visualization with wristed, elbowed instruments and a 3D-high-definition (HD) articulating scope that accesses multiple abdominal quadrants. Celotto et al. argued that the single-arm design is easier to master than the multi-arm systems, and it offers faster docking times. Collisions are minimized through holographic display technology, which allows surgeons to monitor instrumentation, and the system’s triangulation of instruments around the target reduces collision risks (6). Of note, the current single-port system lacks integrated vessel sealers, staplers, suction devices, and advanced energy tools (5,7).

Safety was evaluated in multiple studies included in this review. This is based on postoperative complication rates, which did not differ significantly between single-port and multi-port robotic colectomy (Table 1).

Single-port robotic colectomy has been associated with reduced postoperative analgesic requirements, a quicker return of bowel function, shorter hospital stays, and greater cosmetic satisfaction compared with outcomes after conventional laparoscopic and robotic multiport surgery (3,7). Operative time data are well established for multiport robotic procedures and are similar to those reported thus far for single-port robotic procedures (7,9,10) (Table 1). Operative times for single-port robotic surgeries may be further reduced as surgeons gain experience with the technique.

Several studies report shorter hospital stays with single-port techniques—median between four and seven days—compared to traditional laparoscopic or multiport approaches (3,7,10) (Table 1). Recent studies indicate that estimated blood loss in single-port colectomy tends to be higher than in multiport robotic procedures (5) (Table 1).

Regarding complications, Stylandi et al. found no significant difference in morbidity between single-port robotic and laparoscopic colectomy (4). Most documented complications are minor, classified as Clavien-Dindo grade II or below, including transfusions, abscesses, ileus, and readmissions, with no significant complications reported (11). However, the lack of compatible instruments has been reported as a significant barrier, as the single-port technique requires additional, high-cost equipment, posing financial challenges and limiting access to the procedure (12).

Strengths

To the authors’ knowledge, this report is the first literature review in the last decade to focus on the robotic single-port colectomy technique, thereby filling a critical gap in the current literature.

Limitations

Limited data are available for comparison with single-port and multi-port laparoscopic colectomy and multi-port robotic techniques, which limits the ability to draw significant conclusions. The included studies demonstrated substantial heterogeneity in type and methods. The heterogeneity may contribute to the differences observed in outcomes and must be acknowledged when drawing conclusions from this study. Examples include colon resection type (i.e., location such as right vs. left), oncologic resection, and abdominoperineal resection (APR), etc. Each resection type presents unique challenges and may add further technical difficulty to the procedure. One may also consider the heterogeneity of the results of these studies; for example, why did the complication rate in Juo et al. (10) exceed those in Cho et al. (3) and Kim et al. (11)? Similarly, when comparing SPR colectomy vs. multiport laparoscopic (MPL) colectomy, why did Byrn et al. (24) find MPL to have superior lymph node yield compared to SPR, while Kim et al. (21) reported higher lymph node yield with SPR? Furthermore, many claims in the existing literature lack support from statistically significant data. RCTs have been conducted on multi-port robotic techniques as well as single-port and multi-port laparoscopic techniques; however, there are currently no published RCTs comparing single-port robotic colectomy with other methods (13,15). More studies should be performed, on a larger scale, to achieve adequate statistical significance for this data. Additional evidence supporting the superiority of single-port vs. traditional techniques may include studies that address long-term outcomes, oncologic data and outcomes, and learning-curve data.

Conclusions

Adoption of single-port robot-assisted laparoscopic surgery has been slow, despite preliminary evidence of its safety and feasibility. Limited data are available for comparison with laparoscopic and multi-port robotic techniques, which poses a challenge for drawing significant conclusions. More studies should be performed, on a larger scale, to achieve adequate statistical significance for this data. As it stands, single-port colectomies are not being performed frequently, which could be due to ergonomic challenges and inaccessibility to required instruments. Additional reasons may include a lack of exposure to and experience with single-port robotic surgery. If further research is conducted on this technique, demonstrating the advantages and superiority of single-port over multi-port procedures, more surgeons will likely attempt single-port colectomies.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-56/rc

Peer Review File: Available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-56/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://ales.amegroups.com/article/view/10.21037/ales-2025-1-56/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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doi: 10.21037/ales-2025-1-56
Cite this article as: Kay K, Fader J, Elias A. Single-port robotic colectomy: a literature review. Ann Laparosc Endosc Surg 2026;11:17.

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