Minimally invasive surgery for Crohn's disease (CD) remains challenging due to severe bowel inflammation and the technically demanding intracorporeal suturing required for bowel‐preserving procedures. Strictureplasties are an established alternative to bowel resection in selected patients with stricturing CD, helping to preserve bowel length and reduce the risk of short bowel syndrome [1]. The enhanced dexterity and precision provided by robotic platforms may facilitate the performance of these procedures [2, 3, 4].
Video 1 demonstrates a step‐by‐step [5] robotic‐assisted ileal Heineke–Mikulicz strictureplasty using the da Vinci Xi system. Trocar placement is illustrated, with trocars placed along a line extending from the left midclavicular line to the suprapubic region, including an additional AirSeal port. After identification of the stenotic segment, a longitudinal antimesenteric enterotomy is performed across the stricture and extended until healthy bowel is reached, continuing 1–2 cm beyond the diseased segment. One supporting 3–0 monofilament stitch is placed, approximating both ends of the enterotomy and defining the midpoint of the future strictureplasty (Figure 1). This manoeuvre facilitates tension‐free closure and improves exposure for suturing.
VIDEO 1.
Step‐by‐step demonstration of robotic‐assisted Heineke–Mikulicz strictureplasty, emphasizing the key technical steps for a safe and reproducible procedure. Video content can be viewed at https://onlinelibrary.wiley.com/doi/10.1111/codi.70587.
FIGURE 1.
Robotic Heineke‐Mikulicz strictureplasty for ileal Crohn's disease A supporting 3–0 monofilament stitch is placed to mark the midpoint of the strictureplasty.
The enterotomy is then closed transversely using a continuous 2–0 barbed suture. Closure is performed in two directions, from each end towards the midpoint, achieving a wide lumen and completing the Heineke–Mikulicz reconstruction.
Video 1 highlights key technical steps and demonstrates the feasibility of robotic‐assisted strictureplasty as a bowel‐preserving option in patients with stricturing CD. The robotic platform may facilitate intracorporeal suturing and improve ergonomics during complex reconstructive procedures.
AUTHOR CONTRIBUTIONS
Maria Cigognini: Writing – original draft; visualization; writing – review and editing. Eloy Espin‐Basany: Validation; supervision. Alba Martín del Rey: Writing – original draft; writing – review and editing; visualization. Marc Martí Gallostra: Resources; supervision; conceptualization; validation. Miquel Kraft: Conceptualization; writing – original draft; writing – review and editing; visualization; supervision; validation. Gianluca Pellino: Supervision; conceptualization; validation.
CONFLICT OF INTEREST STATEMENT
No conflicts of interest to declare in relation to the current submission.
ETHICS STATEMENT
This study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. For this type of study, formal ethical approval was not required. Written informed consent for the surgical procedure and for publication of anonymized clinical data and video material was obtained from the patient.
PERMISSION TO REPRODUCE
Permission is granted for reproduction across other sources.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.