Comparison of advanced techniques for local excision of rectal lesions: a case series

Abstract

Background Robotic transanal minimally invasive surgery (R-TAMIS) is an appealing alternative to transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) for benign and early malignant rectal lesions that are not amenable to traditional open transanal excision. However, no studies to our knowledge have directly compared the three techniques. This study sought to compare peri-operative and pathologic outcomes of the three approaches. Methods The records of 29 consecutive patients who underwent TEM, TAMIS, or R-TAMIS at a single academic center between 2016 and 2020 were reviewed. Intra-operative details, pathological diagnosis and margins, and post-operative outcomes were recorded. The three groups were compared using chi-square and Kruskal–Wallis tests. Results Overall, 16/29 patients were women and the median age was 57 (interquartile range (IQR): 28–81). Thirteen patients underwent TEM, six had TAMIS, and 10 had R-TAMIS. BMI was lower in the R-TAMIS patients (24.7; IQR 23.8–28.7), than in TEM (29.3; IQR 19.9–30.2), and TAMIS (30.4; IQR 26.6–32.9) patients. High grade dysplasia and/or invasive cancer was more common in TAMIS (80%) and R-TAMIS (66.7%) patients than in TEM patients (41.7%). The three groups did not differ significantly in tumor type or distance from the anal verge. No R-TAMIS patients had a positive surgical margin compared to 23.1% in the TEM group and 16.7% in the TAMIS group. Length of stay (median 1 day for TEM and R-TAMIS patients, 0 days for TAMIS patients) and 30-day readmission rates (7.7% of TEM, 0% of TAMIS, 10% of R-TAMIS patients) also did not differ among the groups. Median operative time was 110 min for TEM, 105 min for TAMIS, and 76 min for R-TAMIS patients. Conclusions R-TAMIS may have several advantages over other advanced techniques for transanal excisions. R-TAMIS tended to be faster and to more often result in negative surgical margins compared to the two other techniques.

Robotic transanal excision of rectal lesions: expert perspective and literature review

“…Robotic platforms offer several advantages for this surgery, including the ability to work in a small space with improved ergonomics and enhanced range of motion as well as superior 3D visualization [ 3 , 4 ]. In a prior study [ 5 ], we compared robotic with laparoscopic TAMIS and traditional TEM, finding that all ten patients who underwent R-TAMIS procedures had negative surgical margins, as opposed to 10/13 in the TEM group and 5/6 in the TAMIS group. Furthermore, median operative times were lower for R-TAMIS (76 min) compared to TEM (110 min) and TAMIS (105 min).…”

Robotic Transanal Minimally Invasive Surgery (rTAMIS): Large Tubulovillous Adenoma

“…The application of the da Vinci robotic surgical system to the TAMIS platform for the performance of transanal surgery has been proven feasible and safe in clinical reports. [1][2][3][4] The largest case series to date was reported by Lui et al 1 Thirty-four patients with rectal lesions located from 2 to 15 cm from the dentate line and 4.5 cm in maximal diameter were successfully resected. 1 The average operative time was 100 ± 70 min, with a robotic console time of 76 ± 67 min.…”