Robotic transanal minimally invasive surgery – technical, oncological and patient outcomes from a single institution

Abstract

Aim Robotic transanal minimally invasive surgery (R-TAMIS) is gaining traction around the globe as an alternative to laparoscopic conventional TAMIS for local excision of benign and early malignant rectal lesions. The aim was to analyse patient and oncological outcomes of R-TAMIS for consecutive cases in a single centre. Methods A prospective analysis of consecutive R-TAMIS procedures over a 12-month period was performed. Data were collated from hospital databases and theatre registers. Results Eleven patients (six men, five women), mean age 69.81 years (51À92 years), underwent R-TAMIS over 12 months utilizing a da Vinci Xi platform. The mean lesion size was 36 mm (20-60 mm) with a mean distance from the anal verge of 7.5 cm (3-14 cm). Five lesions were posterior in anatomical location, four anterior, one right lateral and one left lateral. All procedures were performed in the lithotomy position using a GelPOINT Path Platform. Mean operative time was 64 min (40-100 min). Complete resection was achieved in 10/11 patients with two patients being upgraded to a diagnosis of adenocarcinoma. Nine patients were diagnosed with dysplastic lesions. Four patients had a false positive diagnosis of an invasive tumour on MRI. Six patients required suturing for full-thickness resections. One patient had a postoperative bleed requiring repeat endoscopy and clipping. One patient (full-thickness resection of T3 tumour) proceeded to a formal resection without difficulty with no residual disease (T0N0, 0/22). One patient with a fully resected T2 tumour is undergoing a surveillance protocol. The mean length of stay was 1 day with two patients having a length of stay of 2 days and one patient of 4 days. Conclusion R-TAMIS could potentially represent a safe novel approach for local resection of rectal lesions.

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

“…Recently, the extensive development of laparoscopic and minimally invasive tools is expanding the possibilities of endoluminal surgery [ 19 ], and local rectal excision can currently be performed using not only the transanal approach or TEM equipment but also the transanal modified single-port procedure, known as the TAMIS procedure [ 5 ], or even robotic surgery [ 20 ]. Most postoperative complications associated with local full-thickness rectal excision (with either TEM or TAMIS) can be easily managed and usually occur during the first postoperative month [ 21 – 23 ].…”

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

“…As robotic TAMIS gains traction as a technique for transanal excision of benign and early malignant rectal lesions, a handful of series have described the outcomes [ 6 – 10 ], but none compared R-TAMIS to TAMIS and TEM. Our study directly compared these three groups at a single tertiary academic institution with respect to perioperative and pathological outcomes.…”

Local full-thickness excision for sessile adenoma and cT1-2 rectal cancer: long-term oncological outcome

“…Minimally invasive instrumentation is continually evolving, and local rectal excision can currently be performed using the transanal approach, TEM equipment, transanal minimally invasive surgery [ 40 ], or even robotic surgery [ 41 ]; whatever the technique, surgeons must be part of a multidisciplinary specialized team prepared to discuss any particular case and translate this debate to patients to incorporate their opinions into the decision-making process. Patients should be engaged in a partnered dialog in which the actual risks and benefits of treatment options are presented.…”