A technical report published in Diseases of the Colon & Rectum describes a novel robotic single-port Hartmann reversal performed entirely through the existing colostomy site. This scar-sparing strategy converts the stoma opening into the operative access point, avoiding additional abdominal ports.

The technique was performed in five carefully selected patients. Following circumferential peristomal dissection, the colonic limb was mobilized and the circular stapler anvil was secured. A single-port robotic platform was then introduced through the stoma site to complete adhesiolysis, descending-colon and splenic-flexure mobilization, rectal-stump identification, and a tension-free colorectal anastomosis.

Reported Outcomes

• No additional laparoscopic ports were required.
• Mean operative time was approximately 199 minutes.
• No intraoperative complications occurred.
• No major postoperative morbidity was reported.
• Mean postoperative hospital stay was 4 days.

Technical Significance

Hartmann reversal is frequently challenging because of:

• Dense intra-abdominal adhesions.
• Difficulty identifying the rectal stump.
• Limited pelvic exposure.
• Requirement for adequate splenic-flexure mobilization.
• Risk of enterotomy during adhesiolysis.
• Need to achieve a well-perfused, tension-free anastomosis.

The robotic single-port platform may improve ergonomics and instrument articulation compared with conventional single-incision laparoscopy. Three-dimensional visualization and wristed instruments may be especially useful in the confined left lower quadrant and pelvis.

Clinical Relevance

This early experience suggests that the colostomy site can serve as a practical natural access route for robotic restoration of intestinal continuity. The technique may reduce additional abdominal-wall trauma and improve cosmesis, but broader adoption requires careful case selection, advanced robotic colorectal experience, and readiness to add ports or convert when adhesions or anatomy compromise safety.

Source: https://pubmed.ncbi.nlm.nih.gov/42461999/

Standardized Laparoscopic En Bloc Para-Aortic Lymphadenectomy Described for Selected Colorectal Cancer Metastasis

A second technical report in Diseases of the Colon & Rectum presents a structured laparoscopic method for en bloc para-aortic lymph-node dissection extending to the level of the left renal vein in selected patients with colorectal cancer and isolated para-aortic nodal disease.

The procedure is based on clearly defined anatomical boundaries and a reproducible dissection sequence.

Key Anatomical Landmarks

The operative field is defined by:

• Left ureter and gonadal vessels.
• Psoas muscle.
• Left common iliac vein.
• Contralateral ureter and gonadal vessels.
• Aorta and inferior vena cava.
• Left renal vein as the proximal limit.

Dissection proceeds from distal to proximal and from right to left, with careful control of major lymphatic channels to reduce postoperative lymphatic leakage. Preservation of sympathetic ganglia and autonomic nerve structures is also emphasized.

Illustrative Case

The technique was demonstrated in a 26-year-old woman with sigmoid colon cancer and isolated para-aortic nodal metastasis.

Reported outcomes included:

• Operative time: approximately 380 minutes.
• Estimated blood loss: approximately 100 mL.
• Uneventful postoperative recovery.
• Twenty-three para-aortic lymph nodes retrieved.
• Two metastatic lymph nodes identified.
• No lymphocele or recurrence during 9 months of follow-up.

Clinical Significance

Para-aortic lymph-node metastasis usually represents systemic disease, and surgical clearance should therefore be considered only in highly selected patients following multidisciplinary evaluation. Important considerations include:

• Absence of widespread metastatic disease.
• Response to systemic therapy.
• Feasibility of complete nodal clearance.
• Vascular involvement.
• Patient fitness and expected oncologic benefit.

Clinical Relevance

For advanced laparoscopic colorectal surgeons, the article provides a useful anatomical roadmap for one of the most technically demanding retroperitoneal dissections. The oncologic value remains uncertain without longer follow-up and comparative evidence, but procedural standardization may improve safety when para-aortic lymphadenectomy is considered appropriate.

Source: https://pubmed.ncbi.nlm.nih.gov/42461998/

Urinary Tract Endometriosis Requires Multidisciplinary Laparoscopic and Robotic Planning

A review published in Current Opinion in Obstetrics and Gynecology summarizes contemporary management of urinary tract endometriosis, a complex form of deep infiltrating endometriosis affecting the bladder, ureters, and surrounding pelvic structures.

Urinary tract involvement may be clinically silent, particularly in ureteric disease, and can progressively cause obstruction, hydronephrosis, renal impairment, or irreversible loss of renal function.

Diagnostic Strategy

The review emphasizes detailed preoperative mapping using:

• Expert transvaginal ultrasonography.
• Pelvic magnetic resonance imaging.
• Renal tract ultrasonography when obstruction is suspected.
• Renal-function testing.
• Selective cystoscopy or additional urologic imaging.

Surgical Options

Treatment should be individualized according to the location, depth, and extent of disease. Minimally invasive options may include:

• Bladder shaving.
• Full-thickness bladder disc excision.
• Partial cystectomy.
• Ureterolysis.
• Segmental ureteric resection.
• Ureteroureterostomy.
• Ureteroneocystostomy.
• Combined bowel and urinary tract resection.

Medical therapy may suppress symptoms but does not reliably resolve fixed ureteric obstruction or protect renal function in advanced disease.

Clinical Relevance

For gynecologic laparoscopic and robotic surgeons, the principal safety message is that ureteric endometriosis must not be overlooked. Early involvement of urology is advisable when there is hydronephrosis, ureteric narrowing, bladder invasion, suspected renal compromise, or a likely requirement for reconstructive urinary surgery. Long-term surveillance should assess symptoms, recurrence, renal drainage, and kidney function.

Source: https://pubmed.ncbi.nlm.nih.gov/42301255/

Laparoscopic Appendectomy Case Report Outlines Safe Anesthetic Management for Myotonia Congenita

An AANA Journal case report describes the anesthetic management of a 57-year-old man with myotonia congenita undergoing elective interval laparoscopic appendectomy after previous perforated appendicitis and drainage.

Myotonia congenita is a skeletal-muscle channelopathy characterized by delayed muscle relaxation. Surgery and anesthesia may trigger sustained muscular contractions, respiratory difficulty, hyperkalemia-related concerns, postoperative weakness, or prolonged recovery.

Perioperative Strategy

The anesthetic team used:

• Bilateral ultrasound-guided quadratus lumborum blocks.
• Total intravenous anesthesia.
• Avoidance of succinylcholine.
• Avoidance of volatile anesthetic agents.
• Minimal neuromuscular blockade.
• Sugammadex for neuromuscular reversal.
• Active maintenance of normothermia.
• Opioid-sparing multimodal analgesia.

Outcome

The laparoscopic appendectomy and recovery were uncomplicated. The patient:

• Reported no pain in the recovery area.
• Required no postoperative opioids.
• Developed no myotonic episode.
• Was discharged home on the same day.

Clinical Relevance

Although based on a single patient, the report provides a practical perioperative framework for laparoscopic surgery in patients with myotonic disorders. Surgeons should identify neuromuscular disease during preoperative assessment, communicate it clearly to anesthesia, avoid triggering medications, prevent hypothermia and shivering, and consider regional blocks to reduce pain-related muscular stimulation.

Source: https://pubmed.ncbi.nlm.nih.gov/42490320/

Key Takeaway

Today’s evidence highlights how advanced minimally invasive surgery increasingly depends on innovative access strategies, standardized anatomical dissection, multidisciplinary planning, and individualized anesthesia. Robotic trans-stomal Hartmann reversal may reduce additional abdominal-wall trauma, structured para-aortic lymphadenectomy can improve technical reproducibility, urinary tract endometriosis requires coordinated gynecologic-urologic management, and careful anesthetic planning can permit safe same-day laparoscopy in patients with myotonic disorders.