title: Hand-assisted hybrid laparoscopic-robotic total proctocolectomy with ileal pouch--anal anastomosis.
abstract: OBJECTIVE
  Few studies have reported minimally invasive total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We herein report a novel hand-assisted hybrid laparoscopic-robotic technique for patients with FAP and UC.
  
  
  METHODS
  Between February 2010 and March 2014, six patients underwent hand-assisted hybrid laparoscopic-robotic total proctocolectomy with IPAA. The abdominal colectomy was performed laparoscopically with hand assistance through a transverse suprapubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Surgical System. The IPAA was hand-sewn through a trans-anal approach. The procedure was complemented by a temporary diverting loop ileostomy.
  
  
  RESULTS
  The mean hand-assisted laparoscopic surgery (HALS) time was 154.6 (±12.8) min whereas the mean robotic time was 93.6 (±8.1) min. In all cases, a nerve-sparing proctectomy was performed, and no conversion to traditional laparotomy was required. The mean postoperative hospital stay was 13.2 (±7.4) days. No anastomotic leakage was observed. To date, no autonomic neurological disorders have been observed with a mean of 5.8 (±1.3) bowel movements per day.
  
  
  CONCLUSIONS
  The hand-assisted hybrid laparoscopic-robotic approach to total proctocolectomy with IPAA has not been previously described. Our report shows the feasibility of this hybrid approach, which surpasses most of the limitations of pure laparoscopic and robotic techniques. Further experience is necessary to refine the technique and fully assess its potential advantages.
authors.affiliation: General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Morelli
authors.forename: Simone
authors.initials: S
authors.lastname: Guadagni
authors.forename: Maria Donatella
authors.initials: MD
authors.lastname: Mariniello
authors.forename: Niccolò
authors.initials: N
authors.lastname: Furbetta
authors.forename: Roberta
authors.initials: R
authors.lastname: Pisano
authors.forename: Cristiano
authors.initials: C
authors.lastname: D'Isidoro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Caprili
authors.forename: Emanuele
authors.initials: E
authors.lastname: Marciano
authors.forename: Giulio
authors.initials: G
authors.lastname: Di Candio
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult