Robotic transanal microsurgery for high early rectal neoplasia (T0-T1, N0 lesions), case series of 10 patients

Arnott, Suzanne; Skancke, Matthew; Obias, Vincent

doi:10.1002/rcs.1956

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…The primary interface was the GelPOINT™ Path Transanal Access Platform used in 20 of the 25 studies (80%). The Covidien SILS™ port was used in two studies from Arnott et al [ 21 ] and Paull et al [ 28 ]. A glove port was utilized in three studies, in one study together with a circular anal dilator [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the 11 patients with a wrong perioperative staging, they were offered more radical surgery (total mesorectal excision (TME) or LAR) and/or chemoradiation therapy [ 8 , 15 , 16 , 26 , 25 , 33 ]. The rest were 22 carcinoid/NET tumors [ 8 , 21 , 22 , 25 , 30 , 34 ], nine excisions with complete clinical-pathological response (ypT0) [ 27 , 33 , 34 ], six scar polypectomies [ 14 , 15 ], four GIST-tumors [ 25 , 27 , 34 ], four non-neoplasias [ 33 ], two rectal ulcers [ 30 ], and one submucosal leiomyoma [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…The Clavien–Dindo score from 1 to 5 was 9:9:13:0:0. Of the 322 local excisions, 14 (4.3%) required conversions [ 15 , 16 , 21 , 28 , 34 ]. No mortality was reported.…”

Section: Resultsmentioning

confidence: 99%

“…No mortality was reported. The most frequent complication was peritoneal entry ( n = 7, 2.1%) [ 14 – 16 , 18 , 21 , 28 ], four (1.2%) of them needed conversion for suturing [ 18 , 21 , 28 ], another two cases had laparoscopy with no positive finding [ 14 , 16 ]. Post-operative bleeding was reported in six cases (1.9%) [ 17 , 20 , 25 , 26 , 32 ], where three (0.9%) required endoscopic therapy [ 25 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Arnott et al, Paull et al and Tomassi et al described one case each with a specimen fragmentation. Temporary anal stenosis was seen twice [ 21 , 28 ]. There were two (0.6%) respiratory infections [ 17 , 20 ], one case with clostridium difficile [ 8 ], one case with tenesmus [ 25 ], and one case with stool incontinence for 2 weeks [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

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Robot-assisted TAMIS: a systematic review of feasibility and outcomes

et al. 2023

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Background In the advancement of transanal local excision, robot-assisted transanal minimal invasive surgery is the newest development. In the confined area of the rectum, robot-assisted surgery should, theoretically, be superior due to articulated utensils, video enhancement, and tremor reduction, however, this has not yet been investigated. The aim of this study was to review the evidence reported to-date on experience of using robot-assisted transanal minimal invasive surgery for treatment of rectal neoplasms. Methods A comprehensive literature search of Embase and PubMed from May to August 2021were performed. Studies including patients diagnosed with rectal neoplasia or benign polyps who underwent robot-assisted transanal minimal invasive surgery were included. All studies were assessed for risk of bias through assessment tools. Main outcome measures were feasibility, excision quality, and complications. Results Twenty-five studies with a total of 322 local excisions were included. The studies included were all retrospective, primarily case-reports, -series, and cohort studies. The median distance from the anal verge ranged from 3.5 to 10 cm and the median size was between 2.5 and 5.3 cm. Overall, 4.6% of the resections had a positive resection margin. The overall complication rate was at 9.5% with severe complications (Clavien–Dindo score III) at 0.9%. Conclusion Based on limited, retrospective data, with a high risk of bias, robot-assisted transanal minimal invasive surgery seems feasible and safe for local excisions in the rectum. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09853-z.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The Clavien–Dindo score from 1 to 5 was 9:9:13:0:0. Of the 322 local excisions, 14 (4.3%) required conversions [ 15 , 16 , 21 , 28 , 34 ]. No mortality was reported.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Robot-assisted TAMIS: a systematic review of feasibility and outcomes

et al. 2023

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

et al. 2022

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Transanal excision of benign lesions, moderately or well-differentiated rectal T1 adenocarcinomas is typically completed via transanal endoscopic microsurgery (TEM) or laparoscopic transanal minimally invasive surgery (TAMIS). Robotic platforms provide ergonomic comfort in an enclosed space, enhanced range of motion, and superior 3D visualization. This study sought to perform a literature review of robotic TAMIS (R-TAMIS) and provide expert commentary on the technique. A Pubmed literature search was performed. Study design, robot type, indication, techniques compared, surgical margins, conversion, complications, operative time, estimated blood loss, patient positioning, and defect closure were collected from included articles. Expert opinion on pre-operative planning, technical details, and possible pitfalls was provided, with an accompanying video. Twelve articles published between 2013 and 2022 were included. Five were case reports, three case series, two prospective cohort studies, one retrospective cohort study, and one Phase II trial. The Da Vinci Si (n = 3), Xi (n = 2), single port (n = 3) and flex robotic system (n = 2) were used. Five studies reported negative surgical margins, one reported positive margins, and six did not comment. Operating room time ranged from 45 to 552 min and EBL ranged from 0 to 100 mL. Patient positioning varied based on lesion location but included supine, prone, modified lithotomy, and prone jackknife positions. 11/12 studies reported defect closure, most commonly with V-Loc absorbable suture. We recommend pre-operative MRI abdomen/pelvis, digital rectal exam, and rigid proctoscopy; prone jackknife patient positioning to avoid collisions with robotic arms; and defect closure of full-thickness excisions with backhanded running V-Loc suture.

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A prospective phase II clinical trial/IDEAL Stage 2a series of single‐port robotic colorectal surgery for abdominal and transanal cases

Marks,

Yang,

Spitz

et al. 2023

Colorectal Disease

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AimSlow laparoscopy adoption accelerated the uptake of robotic surgery. However, the current robotic platforms have limitations in transanal applications and multiple port sites. The da Vinci single‐port (SP) robot is currently used on trial for colorectal surgery, and broad assessment of outcomes is needed. We aimed to report findings of a phase II clinical trial of SP robotic colorectal surgery.MethodsA sequentially reported prospective case series was performed on patients using SP robotics at a tertiary referral centre from 1 October 2018 to 31 August 2021. Cases were stratified into abdominal and transanal cohorts. Demographics, intra‐operative variables and 30‐day postoperative outcomes were evaluated. Univariate analysis was performed, with statistical process control for the docking process. Main outcomes were conversion rates, morbidity, mortality and point of standardization of docking.ResultsIn all, 133 patients were included: 93 (69.92%) abdominal and 40 (30.08%) transanal. The main diagnosis was rectal cancer (n = 59) and the procedure performed a robotic transanal abdominal transanal radical proctosigmoidectomy (n = 30). There were no conversions to open surgery. Two abdominal (2.15%) and three transanal cases (7.50%) were converted to laparoscopy. All colorectal adenocarcinomas had negative margins, proper lymph node harvest and complete mesorectal excision, as appropriate. Docking became a standardized process at cases 34 (abdominal) and 23 (anorectal). After surgery, bowel function returned on mean day 2 (abdominal) and 1 (transanal). The morbidity rate was 15.05% (abdominal) and 27.50% (transanal). There were two major morbidities in each cohort. Overall, there were three (2.65%) readmissions, one reoperation and no mortality.ConclusionsSingle‐port robotics is feasible for all types of colorectal procedures, with good clinical and oncological outcomes. With this development in colorectal surgery, further studies can develop best practices with this novel technology.

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Robotic transanal microsurgery for high early rectal neoplasia (T0-T1, N0 lesions), case series of 10 patients

Abstract: Transanal robotic surgery may provide the colorectal surgeon a method to address rectal lesions farther from the anal verge.

Cited by 5 publications

References 23 publications

Robot-assisted TAMIS: a systematic review of feasibility and outcomes

Robot-assisted TAMIS: a systematic review of feasibility and outcomes

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

A prospective phase II clinical trial/IDEAL Stage 2a series of single‐port robotic colorectal surgery for abdominal and transanal cases

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