Langenbeck's Archives of Surgery

, Volume 400, Issue 6, pp 741–748 | Cite as

Hand-assisted hybrid laparoscopic–robotic total proctocolectomy with ileal pouch–anal anastomosis

  • Luca Morelli
  • Simone Guadagni
  • Maria Donatella Mariniello
  • Niccolò Furbetta
  • Roberta Pisano
  • Cristiano D’Isidoro
  • Giovanni Caprili
  • Emanuele Marciano
  • Giulio Di Candio
  • Ugo Boggi
  • Franco Mosca
How-I-Do-It article



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.


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.


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.


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.


Robotic proctectomy Hand-assisted laparoscopic surgery Ileal pouch–anal anastomosis Inflammatory bowel disease Familial adenomatous polyposis 



We thank Fabrizio Michelassi, M.D. for his review of the manuscript and constructive criticisms.

Study supported by ARPA foundation,

Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.

Authors’ contributions

Study concept and design: Morelli, Guadagni, Pisano, Mariniello, Furbetta, D’isidoro, Caprili, Marciano, Boggi, Di Candio and Mosca. Acquisition of data: Morelli, Guadagni, Pisano, D’isidoro, Caprili, Furbetta, Marciano and Mariniello. Analysis and interpretation of data: Morelli, Boggi, Di Candio and Mosca. Drafting of the manuscript: Morelli, Guadagni and Mariniello. Critical revision of the manuscript for important intellectual content: Morelli, Boggi, Di Candio and Mosca,.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Luca Morelli
    • 1
    • 3
  • Simone Guadagni
    • 1
  • Maria Donatella Mariniello
    • 1
  • Niccolò Furbetta
    • 1
  • Roberta Pisano
    • 1
  • Cristiano D’Isidoro
    • 1
  • Giovanni Caprili
    • 1
  • Emanuele Marciano
    • 1
  • Giulio Di Candio
    • 1
  • Ugo Boggi
    • 2
  • Franco Mosca
    • 1
    • 3
  1. 1.General Surgery Unit, Department of Oncology, Transplantation and New TechnologiesUniversity of PisaPisaItaly
  2. 2.General and Transplantation Surgery, Department of Oncology Transplantation and New TechnologiesUniversity of PisaPisaItaly
  3. 3.EndoCAS (Center for Computer Assisted Surgery)University of PisaPisaItaly

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