# Single-Stapled Double Purse-String Anastomotic (SIA) Technique in Robotic Malignant Sigmoid Resections—A Danish Single-Center Study

## TL;DR

This study explores a new surgical technique called SIA in robotic cancer surgeries to reduce anastomotic leaks, with early results suggesting it is feasible and safe.

## Contribution

The study introduces and evaluates the single-stapled double purse-string anastomotic (SIA) technique in robotic sigmoid resections for cancer.

## Key findings

- The median time to perform SIA was 11.5 minutes.
- Only 9.5% of patients experienced 30-day postoperative complications.

## Abstract

Background: Stapled end-to-end anastomosis has a leakage rate close to 10%. Studies indicate that most leaks occur where stapler lines overlap. The single-stapled double purse-string suture technique (SIA) eliminates stapler line overlaps in low anterior resection (LAR) and may thereby decrease leakage rates. Methods: This single-arm, single-center study prospectively and consecutively registered all patients with sigmoid colonic cancer planned for robotic sigmoid resection with primary anastomosis over a two-year period. The primary outcome was time to perform SIA and secondary outcomes were total operative time and short-term complications. Results: The study group consisted of twenty-one patients. The median time to perform SIA was 11.5 min. Two patients (9.5%) experienced 30-day postoperative complications. One patient had ischemic bowels and pneumonia postoperatively and another had an anastomotic leakage grade C. Conclusions: This study has several limitations, including a small sample size, lack of comparator group, and short follow-up period. However, these preliminary results may indicate the SIA technique to be feasible without prolonging the operation substantially. Larger series are, however, evidently needed to evaluate the SIA technique in further detail to elucidate whether the technique is generalizable and safe.