To compare the short-term clinical efficacy of robotic single-incision plus one-port total colectomy (TC) versus multi-port laparoscopic total colectomy in the treatment of slow transit constipation (STC).

A retrospective study with frequency matching was conducted. The clinical data of 50 patients diagnosed with STC who underwent surgical treatment in the First Affiliated Hospital of Soochow University from June 2021 to November 2025 were collected. According to the surgical method, the patients were divided into the robot-assisted single-incision plus one-port group (25 cases) and the laparoscopic multi-port group (25 cases). Baseline data and perioperative indicators were compared between the two groups, including operative duration, intraoperative blood loss, pain score, time to first ambulation, first oral feeding and first defecation, and length of hospital stay. Short-term postoperative follow-up indicators covered the Wexner Constipation Score (WCS), complete spontaneous bowel movements (CSBM), Gastrointestinal Quality of Life Index (GIQLI), Bristol Stool Form Scale (BSFS), and incision cosmetic satisfaction score.

There were no statistically significant differences between the two groups in baseline characteristics, including sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification (P＞0.05); however, age differed to some extent between the groups (t=−2.025, P=0.048). All operations were completed successfully without conversion to open laparotomy or severe intraoperative complications. Compared with the multi-port laparoscopic group, the robotic-assisted single-incision plus one-port group required longer operative duration [(293.52±60.57) min vs.(235.56±56.31) min, t=3.504, P＜0.001]. However, the time to first defecation [(25.00±5.00) h vs.(28.92±6.94) h, t=−2.423, P=0.020], time to first ambulation [(42.52±12.43) h vs. (51.92±13.07) h, t=−2.606, P=0.012] and length of hospital stay [(9.08±1.91) d vs. (11.84±2.98) d, t=−3.895, P＜0.001] were shorter in the laparoscopic multi-port group. No statistically significant intergroup differences were observed in intraoperative blood loss, pain scores, WCS, CSBM and GIQLI scores at the 3-month postoperative follow-up, as well as overall postoperative complications (P＞0.05). The incision cosmetic satisfaction score showed a statistically significant difference between the two groups (Z=−3.830, P＜0.001).

Compared with laparoscopic multi-port group, robot-assisted single-incision plus one-port group for STC is equally safe and feasible, and has more advantages in postoperative rapid recovery and incision cosmesis, which can be used as one of the preferred options for individualized minimally invasive treatment of patients with STC.