ArticleAnnals of surgical oncology2026
Robotic Intracorporeal Single-Stapled Anastomosis (RISS) is Associated with Lower Anastomotic Leakage Rates than the Double-Stapled Technique After Minimally Invasive Total Mesorectal Excision for Rectal Cancer.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Single-stapling versus double-stapling technique for rectal anastomosis-meta-analysis.BJS open · 2026Pooled it
- Impact of robotic platform transition on short term outcomes in colorectal cancer surgeries.Journal of robotic surgery · 2026Observational
- Robotic Intracorporeal Single-Stapled Anastomosis (RiSSA): Indications, Technical Benefits, and Current Limitations.The international journal of medical robotics + computer assisted surgery : MRCAS · 2026Review
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9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAlternatives to the double-stapled (DS) technique for creating anastomoses after minimally invasive total mesorectal excision (TME) have been proposed to reduce complications and costs. Robotic intracorporeal single-stapled anastomosis (RISS) was developed as a technically intuitive approach. Standardizing such an intracorporeal robotic technique-which achieves adequate pelvic exposure, precise rectal transection, and secure anastomosis construction-may optimize outcomes, particularly anastomotic leakage (AL).
methodsA cohort study was conducted using our prospective institutional database and included patients < 80 years who underwent minimally invasive elective TME for extraperitoneal rectal cancer. Patients were allocated to the DS (abdominal stapled transection with double-stapled anastomosis) or RISS (robotic intracorporeal rectal transection with single-stapled anastomosis) groups. The exclusion criteria were nonrestorative procedures, intersphincteric resection, open surgery, and no indocyanine green perfusion assessments. The primary endpoint was 90-day clinical or radiological AL.
resultsAmong 380 TMEs, 167 met the inclusion criteria (71 RISS; 96 DS). The 90-day AL rate was significantly lower in the RISS group (5.6% vs. 16.7%; p = 0.032). Reintervention (1.4% vs. 10.4%; p = 0.025), overall morbidity (33.3% vs. 52.5%; p = 0.014), and length of stay (p < 0.0001) were lower following RISS. Multivariable analysis revealed that DS technique (odds ratio [OR] 3.3; p = 0.038) and comorbidities (OR 3.1; p = 0.028) independently predicted AL. Each additional stapler firing increased the risk of AL (OR 1.62; p = 0.016), and ≥3 firings predicted AL (OR 4.92; p = 0.011).
conclusionsCompared with DS, RISS was associated with lower anastomotic leakage, morbidity, and reintervention and shorter hospitalization. This standardized robotic approach is safe, reproducible, and potentially cost effective.
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