Background: Splenic flexure cancers represent a small but anatomically complex subset of colorectal malignancies, characterised by variable vascular supply and lymphatic drainage. This has led to ongoing uncertainty regarding the optimal extent of resection and level of vascular ligation. With increasing adoption of robotic surgery, a range of operative approaches has been described, although these remain inconsistently reported and poorly synthesised. Aim: We aimed to map operative heterogeneity in robotic splenic flexure cancer surgery, focusing on resection extent, vascular ligation, reconstruction strategy, and technical configuration. Methods: A structured scoping review was performed in accordance with PRISMA-ScR guidelines. MEDLINE (PubMed) and Embase (Ovid) were searched from inception to January 2026. Studies reporting robotic resection for primary splenic flexure colon cancer with extractable operative detail were included. Data were synthesised descriptively and grouped into three tiers based on study design: comparative cohorts, case series, and technical reports. Results: Sixteen studies comprising 97 robotic resections were included. Three were comparative cohort studies; two were case series, and eleven were single-case technical reports. Comparative studies consistently described a flexure-directed segmental resection with preservation of the inferior mesenteric artery and division of the left colic artery. In contrast, there was greater variability in management of the middle colic branches and inferior mesenteric vein. Reconstruction strategy differed across tiers, with extracorporeal anastomosis more commonly reported in comparative cohorts, while intracorporeal techniques were frequently described in technical series. Anastomotic configuration, specimen extraction, and use of indocyanine green fluorescence varied widely. Terminology relating to complete mesocolic excision and D2/D3 lymphadenectomy was inconsistent and often poorly defined. Conclusions: Robotic splenic flexure surgery shows broad agreement in overall resection strategy but considerable variability in vascular control, reconstruction, and technical execution. This likely reflects differences in reporting rather than clear differences in oncological intent. A more consistent and structured operative description is needed to allow meaningful comparison and to support the development of evidence-based approaches in this technically demanding area.

Background Intersphincteric prosthetic implants have emerged as a minimally invasive treatment option for faecal incontinence (FI), positioned between conservative therapies and more invasive surgical or neuromodulatory interventions. However, evidence supporting their effectiveness remains fragmented and largely nonrandomised. Methods A PRISMA-compliant systematic review with exploratory quantitative synthesis was conducted. MEDLINE and Embase were searched from inception to August 2025, with an updated search in January 2026 for nonrandomised studies evaluating intersphincteric prosthetic implants (GateKeeper® or SphinKeeper®) in adults with FI. The primary outcome was the proportion of patients achieving a clinically meaningful response, defined as a ≥ 50% reduction in Vaizey (St Mark’s) score at ≥ 12 months. Where feasible, exploratory pooled analyses of binary responder outcomes were performed using random-effects models. Secondary outcomes, including continence severity, quality of life and complications, were synthesised narratively. Certainty of evidence was assessed using GRADE. Results Fourteen observational studies were included. Two studies reporting comparable binary responder outcomes at approximately 12 months (n = 75) contributed to the primary exploratory synthesis, yielding a pooled responder proportion of 49.3% (95% CI 38.2–60.5%). A sensitivity analysis incorporating three studies reporting study-defined clinical success (n = 129) produced a similar pooled estimate (51.9%, 95% CI 43.3–60.4%). Given the very small number of contributing studies, measures of statistical heterogeneity were uninformative, and interpretation was further limited by the nonrandomised study designs. Quality-of-life outcomes and complication rates were heterogeneous and could not be pooled quantitatively. No procedure-related mortality was reported. Conclusion Exploratory quantitative synthesis suggests that intersphincteric prosthetic implantation may be associated with clinically meaningful symptom improvement in a subset of patients with faecal incontinence. However, the certainty of evidence is low, and pooled estimates should be interpreted as hypothesis-generating. Prospective comparative studies with standardised outcome reporting are required to more clearly define the role of these implants within the treatment pathway. What does this paper add to the literature? This review brings together the fragmented evidence on intersphincteric prosthetic implants for faecal incontinence and, where definitions allowed, summarises clinically meaningful responder outcomes at medium-term follow-up. It shows how limited and heterogeneous the evidence remains and identifies where comparative data are most needed.