778 New Intervention: Transanal Local Excision of Rectal Lesions with CMR Versius Robotic Surgical System

Abstract

Abstract Introduction The Versius robotic surgical system (CMR) is a modular robotic platform. Since its launch in clinical practice in 2019 for General Surgical and Gynaecological procedures it has rapidly expanded into other clinical specialties. We describe its implementation and the world's first series of its use for trans-anal resection of significant rectal lesions. Method The optimum bedside unit set-up and port placement was determined in an exploratory study using dry and wet-lab models prior to clinical implementation. The early intervention panel at NHS Lothian were consulted prior to introducing the technique into clinical practice. The case series of patients undergoing robotic Trans-Anal Minimally Invasive Surgery (rTAMIS) were prospectively identified and data collected retrospectively. Results A total of 12 patients were included in this case series. Data was collected from cases over a 6-month period from December 2021 to June 2022. 8 patients underwent robotic TAMIS using the Versius platform. 2 cases were converted to laparoscopic TAMIS due to external arm clashes. The average length of stay in hospital was 1 day (range 0-3). There was only one Clavien-Dindo grade II morbidity. Conclusions The Versius surgical system is a safe and feasible alternative to TEMS and TAMIS. The technique allows access to the rectum with the advantages of enhanced optics and wristed instruments. We have produced a blueprint for optimised bedside unit positioning and port placement enabling resection of anterior, lateral, and posterior rectal lesions without further patient position changes. Further studies are needed for accurate outcome and cost comparisons to TEMS and TAMIS.