An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surgery

Lino Polese,Raffaele De Caro,Gianfranco Da Dalt,Alice Bressan,Roberto Rizzato,Stefano Merigliano,Andrea Porzionato

doi:10.1007/s00384-020-03641-8

Lino Polese, Raffaele De Caro + Show 5 more

Open Access

https://doi.org/10.1007/s00384-020-03641-8

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Abstract

PurposeThe study aimed to evaluate the feasibility and safety of a new trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS) platform to treat rectal lesions.MethodsARAMIS was first compared with two transanal minimally invasive surgery platforms (SILS Port and GelPOINT Path) on human cadavers. Surgeons with different experience performed running sutures at different distances, at four quadrants, using the three platforms and gave a score to visibility, safety, and maneuverability. ARAMIS was then utilized on patients affected with rectal neoplasia who met the inclusion criteria. Patients and tumor characteristic and results were prospectively collected. The follow-up examinations included proctoscopy at 3, 6, and 12 months.ResultsAccording to surgeons’ scores, ARAMIS improves visibility and safety with respect to other platforms for distances beyond 10 cm. The procedure, which lasted an average of 59 min, was successfully carried out in 14 patients. No intraoperative or postoperative complications were reported. The mean tumor size was 3 cm; they were located a mean of 11 cm from the anal verge. Complete removal of the lesion was possible in 13/14 patients. There was one case of adenoma recurrence at follow-up.ConclusionStudy results showed that ARAMIS, which is equipped with an adjustable rectoscope, can be considered a safe, effective platform for transanal surgery. The rectoscope protects the rectum during the procedure, a particularly important consideration when proximal rectal lesions are being treated. Further clinical studies are warranted to confirm these encouraging results.

Highlights

Transanal surgery for rectal cancer is feasible and widely accepted in early stages
Data analysis showed that the SILS Port provided superior maneuverability for sutures at 8 cm from the anal verge with respect to the GelPOINT Path and anal rectoscopic-assisted minimally invasive surgery (ARAMIS) (p < 0.05); there were no differences with regard to this variable between the GelPOINT Path and ARAMIS
While local transanal excision is associated to high rates of oncologic failures [16,17,18], recent studies have demonstrated that TEM and transanal minimally invasive surgery (TAMIS) transanal endoscopic microsurgery techniques allow access to rectal lesions and ensure highquality full-thickness excisions whose oncologic outcomes are comparable with anterior rectal resection or the Miles procedure [19,20,21,22]

Summary

Introduction

Transanal surgery for rectal cancer is feasible and widely accepted in early stages. According to National Comprehensive Cancer Network guidelines, transanal excision (TAE) can be performed if the lesion is smaller than 3 cm and there is less than 30% of bowel circumference involvement. The TAE technique, which is indicated in cases of earlystage rectal cancer, is able to preserve the function of the anal sphincter and is associated with early recovery and low morbidity with respect to radical rectal resection. Its limitations are that it can be used exclusively for tumors smaller than 4 cm located within 8 cm of the anal verge. With the intent to overcome these limits, minimally invasive transanal excision of early stage rectal neoplasm can be performed by transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS)

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