{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:18:23Z","timestamp":1787811503910,"version":"build-2784847793"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intestinal malrotation results from disrupted midgut rotation and fixation during embryogenesis. Pure duodenal non-rotation (Stringer Type IIa), featuring isolated duodenal malrotation with a normally positioned colon, is extremely rare. Its unique anatomical distortions\u2014specifically the absence of standard duodenal landmarks\u2014present significant challenges for colorectal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case description<\/jats:title>\n                    <jats:p>An asymptomatic 61-year-old male was diagnosed with transverse colon cancer during routine screening. Preoperative three-dimensional computed tomography revealed Type IIa malrotation: a vertically descending duodenum lacking the horizontal portion and a reversed distal relationship between the superior mesenteric artery and vein. We performed a robotic-assisted right hemicolectomy. To navigate the altered anatomy safely, we utilized a lateral-to-medial approach, providing an early anatomical roadmap before vascular dissection. The robotic platform's high-definition visualization facilitated precise identification of distorted vasculature and safe D3 lymphadenectomy. Pathological examination confirmed pT3N0M0, Stage IIA. The postoperative course was uneventful except for a minor surgical site infection; the patient remains recurrence-free at 3-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pure duodenal non-rotation presents unique challenges, including loss of the duodenal C-loop landmark and mesenteric vascular reversal. Preoperative recognition through detailed imaging is essential for safe surgical planning. This case demonstrates that robotic surgery is safe and efficient in complex settings via a strategic lateral-to-medial approach. The accompanying video provides a valuable resource for managing this rare anomaly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1895886","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:34:46Z","timestamp":1787808886000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic right hemicolectomy for transverse colon cancer in a patient with stringer type IIa intestinal malrotation: a case report with intraoperative video"],"prefix":"10.3389","volume":"13","author":[{"given":"Go","family":"Ito","sequence":"first","affiliation":[{"name":"Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dai","family":"Shida","sequence":"additional","affiliation":[{"name":"Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Imaizumi","sequence":"additional","affiliation":[{"name":"Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Mukohyama","sequence":"additional","affiliation":[{"name":"Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoko","family":"Monma","sequence":"additional","affiliation":[{"name":"Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Sakuyama","sequence":"additional","affiliation":[{"name":"Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/S2468-1253(21)00179-5","article-title":"Update on the mesentery: structure, function, and role in disease","volume":"7","author":"Coffey","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"151141","DOI":"10.1016\/j.sempedsurg.2022.151141","article-title":"Diagnosis and management of intestinal rotational abnormalities with or without volvulus in the pediatric population","volume":"31","author":"Svetanoff","year":"2022","journal-title":"Semin Pediatr Surg"},{"key":"B3","first-page":"235","volume-title":"Pediatric Gastrointestinal 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strategy","volume":"18","author":"Shida","year":"2025","journal-title":"Cancers (Basel)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1002\/ags3.12861","article-title":"Robotic right-sided colon cancer surgery: dissecting the outermost layer of the autonomic nerve along the superior mesenteric artery","volume":"9","author":"Shida","year":"2025","journal-title":"Ann Gastroenterol Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"594","DOI":"10.4030\/jjcs.46.594","article-title":"A case of incomplete intestinal malrotation in whom laparoscopic right hemicolectomy was performed for colon cancer","volume":"46","author":"Yoshida","year":"2021","journal-title":"J Jpn Coll Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1895886\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:34:47Z","timestamp":1787808887000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1895886\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":11,"alternative-id":["10.3389\/fsurg.2026.1895886"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1895886","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"1895886"}}