Fully Robotic Total Colectomy in High-Risk Patients and Review of Literature

Background: Robotic total colectomy is a valuable approach for managing complex colorectal diseases. Its role in high-risk patients, especially those with significant comorbidities or synchronous malignancy, remains underreported. Methods: Two high-risk male patients with familial adenomatous polyposis (FAP), one with synchronous colon cancer, underwent fully robotic total colectomy with intracorporeal ileo-pouch-rectal anastomosis and loop ileostomy using the da Vinci Xi system in 2024. A focused review of the recent literature on robotic colectomy was also conducted. Results: The mean age was 68 years, and mean BMI was 33.05 kg/m2. One patient had cirrhosis and obesity; the other had severe obesity and psychiatric comorbidity. Both procedures were completed without conversions or complications. Mean console time was 315 min, and mean hospital stay was 11 days. Conclusions: Fully robotic total colectomy is feasible and safe in high-risk patients. These findings support its expanded role in minimally invasive colorectal surgery.