Hybrid-Hand Assisted Laparoscopic-Robotic Surgery (HALRS) in Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Familiar Adenomatous Polyposis

Background:Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is recommended as a prophylactic procedure in patients diagnosed with familial adenomatous polyposis (FAP). Minimally invasive surgical techniques have recently been used to perform large bowel resections for the treatment of both malignant and benign colonic diseases, including FAP and UC. However, even if laparoscopy has become very popular for colon surgery and is largely used also in rectal surgery, laparoscopic total proctocolectomy with IPAA has not had the same dissemination mostly because of the intrinsic technical limitations of the laparoscopic approach in the deep pelvis. We present our surgical technique of hand-assisted hybrid laparoscopic–robotic total proctocolectomy with restorative IPAA for patients diagnosed with FAP. Materials and Methods:An 18-years old man with FAP and a colonscopy with hundreds of sessile polyps (low-grade dysplasia) was referred to our centre. The colectomy was performed laparoscopically with hand assistance through a suprapubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Si. The IPAA was hand-sewn through a transanal approach. Results: The procedure was successfully completed in 370 min. There were no surgical complications or a need for conversion to laparotomy. The patient had an uneventful recovery and was discharged from hospital after 6 days. Conclusions:We believe that hybrid laparoscopic–robotic proctocolectomy with IPAA is an appealing alternative to laparoscopy and open surgery in selected patients with FAP or UC. The enhanced surgical dexterity offered by robotic assistance is expected to overcome some of the limitations of conventional laparoscopy, thus improving the acceptance of minimally invasive techniques for proctocolectomy with IPAA.