Robotic transanal total mesorectal excision: a pilot study

Abstract

The introduction of transanal minimally invasive surgery (TAMIS) in 2009 allowed colorectal surgeons to approach transanal access with a different perspective. This has lead to the development of TAMIS for total mesorectal excision (TME). We have previously described robotic transanal TME and here report our initial experience with the first three human cases performed at a single institution. Three patients with distal rectal cancer were selective to undergo robotic transanal TME. All resections were carried out with intent to cure; they were performed by a single attending colorectal surgeon over an 11-month period. Three patients underwent robotic transanal TME. The average age was 45 years (range 26-59) with mean BMI of 32 kg/m(2) (range 21-38.5). The average tumor size was 2.5 cm. All lesions were located in the distal 5 cm of the rectum. In each case, the distal and circumferential resection margins were free of tumor. The resection quality of the mesorectal envelope was Grade I and Grade II. There was no major morbidity or mortality on short-term follow-up. Robotic transanal TME is a new modality for en bloc rectal cancer surgery, and the technique is feasible. Further study is necessary to assess the benefit of this novel approach.