Carlotta La Raja

Introduction: Faecal incontinence (FI) remains a debilitating condition with considerable psychosocial burden. Rechargeable sacral neuromodulation (rSNM) systems offer extended battery longevity and MRI compatibility, potentially reducing surgical burden. However, real‐world data on their efficacy, safety and acceptability remain limited. Method: This single‐centre observational cohort study evaluated 37 patients who received rSNM (InterStim™ Micro) for FI between August 2020 and August 2022. Patients completed validated questionnaires (St Mark's FI Score, Rockwood FIQOL, SF‐36) and a structured telephone interview assessing functional outcomes, adverse events and device satisfaction. Clinical records were reviewed for surgical and 3‐ to 5‐year follow‐up data. Results: Median age was 63 years; 61% had a history of obstetric injury. Twenty‐eight patients received rSNM as a replacement for non‐rechargeable systems. Device satisfaction was low: 62% expressed regret and 96% reported challenges with charging. Connectivity issues affected 86% of patients. Six patients underwent device explantation and two required lead revision. Rockwood FIQOL and SF‐36 scores indicated persistent impairment in lifestyle, emotional well‐being and social functioning. Improvements in continence scores were modest and below expectations. Conclusion: Despite theoretical advantages, rSNM provided limited clinical benefit in this cohort. High rates of dissatisfaction, management difficulties and surgical revisions raise concerns about its broader applicability. While the smaller device may suit select patients, non‐rechargeable systems with extended battery life may represent a more acceptable first‐line option. Further studies are needed to better define the role of rSNM in FI management.

BACKGROUND: Proctectomy with IPAA is a promising indication for the single-port approach because the procedure can be performed using a single-port platform placed at the stoma site. A single-port robotic platform may address many of the challenges associated with single-incision laparoscopy. However, it lacks compatible stapling devices. Consequently, performing the distal rectal transection with linear laparoscopic staplers is suboptimal, as it often requires significant enlargement of the abdominal defect at the stoma site. The transanal transection and single-stapled anastomosis technique offers a practical solution, compensating for the absence of staplers while potentially providing additional benefits. IMPACT OF INNOVATION: Integrating the single-port robotic platform with the transanal transection and single-stapled anastomosis technique may provide technical advantages for restorative rectal surgery through a minimally invasive, single-incision approach. This strategy eliminates the need for fascial enlargement, additional ports, and staplers, potentially lowering procedural costs. The use of an exoscope enhances the visualization of the transanal phase and improves the potential for learning. TECHNOLOGY, MATERIALS, AND METHODS: A fully robotic single-port mesenteric lengthening and proctectomy were performed. The pouch was constructed through the stoma site, and the specimen was retrieved transanally. An exoscope-assisted transanal transection and single-stapled anastomosis IPAA was performed. PRELIMINARY RESULTS: The video shows the technique in a 26-year-old male patient with ulcerative colitis. The operation was completed without the need for additional port placement. No intraoperative or postoperative complications occurred. The patient was discharged on postoperative day 4. The ileostomy was reversed after 6 weeks. CONCLUSIONS AND FUTURE DIRECTIONS: The fully robotic single-port technique is feasible and safe in selected cases, particularly in centers with specialized expertise in IPAA surgery and robotic procedures. Its broader implementation will be further supported by the integration of advanced devices into the single-port platform. See New Technology Report Video.

The incidence of rectal cancer (RC) is increasing in the population aged ≤ 49 (early-onset RC-EORC). EORC patients are more likely to present with locally advanced disease at diagnosis than late-onset RC (LORC; aged ≥ 50) patients. As a consequence, more EORC patients undergo neoadjuvant therapies. The response to treatment in EORC patients is still unknown. This study aims to explore the effect of age of onset on the pathological response to neoadjuvant therapies in sporadic locally advanced RC (LARC) patients. Based on an institutional prospectively maintained database, LARC patients undergoing neoadjuvant therapies and radical surgery between January 2010 and December 2022 were allocated to the EORC and LORC groups. The primary endpoint was the rate of incomplete response (Dworak 0–2). A total of 326 LORC and 79 EORC patients were included. Pre-neoadjuvant tumor features were comparable. A significantly higher rate of incomplete response was observed in EORC patients (49% vs. 35%; p = 0.028). From multivariable analysis, early age of onset, smoking and extramural invasion presented as independent risk factors for a worse response. This study demonstrates that an early age of onset is related to a worse response and calls for different multimodal strategies in this group of patients.

The incidence of colorectal cancer (CRC) is increasing in the population aged ≤ 49 (early-onset CRC-EOCRC). Recent studies highlighted the biological and clinical differences between EOCRC and late-onset CRC (LOCRC-age ≥ 50), while comparative results about long-term survival are still debated. This study aimed to investigate whether age of onset may impact on oncologic outcomes in a surgical population of sporadic CRC patients. Patients operated on for sporadic CRC from January 2010 to January 2022 were allocated to the EOCRC and LOCRC groups. The primary endpoint was the recurrence/progression-free survival (R/PFS). A total of 423 EOCRC and 1650 LOCRC was included. EOCRC had a worse R/PFS (p < 0.0001) and cancer specific survival (p < 0.0001) compared with LOCRC. At Cox regression analysis, age of onset, tumoral stage, signet ring cells, extramural/lymphovascular/perineural veins invasion, and neoadjuvant therapy were independent risk factors for R/P. The analysis by tumoral stage showed an increased incidence of recurrence in stage I EOCRC (p = 0.014), and early age of onset was an independent predictor for recurrence (p = 0.035). Early age of onset was an independent predictor for worse prognosis, this effect was stronger in stage I patients suggesting a potentially—and still unknown—more aggressive tumoral phenotype in EOCRC.