Robotic taTME using the da Vinci SP: technical notes in a cadaveric model.

Abstract

Transanal total mesorectal excision (taTME) is an emerging albeit complex technique to treat rectal cancer. The aim of this proof-of-concept preclinical study was to determine the technical feasibility of robotic taTME using the da Vinci SP (dVSP). Two fresh cadavers, one female (case 1) and one male (case2), were used. Focus was given only to the transanal phase of the taTME. Two different clinical scenarios were simulated: in case 1, the tumor was hypothesized to be at 1cm above the anorectal junction; in case 2, at > 4cm. The GelPOINT Path was used as the transanal access platform through which the 2.5cm single port robotic trocar and a 10mm sleeve were inserted. A complete taTME was performed in both cases with a sleeve mucosectomy initiated at the level of the dentate line in case 1. In case 2, the purse-string was created and tightened robotically. At the completion of the procedure, the quality of the mesorectal dissection was verified showing an intact mesorectal fascia in both cases. Operation times were 124 and 106min with a ~ 15min of non-console time for robot positioning and docking. Robotic taTME with the dVSP is technically feasible and might overcome the limits of the traditional laparoscopic approach.