Robotic Transanal Surgery Research Articles

Flexible robotic transanal resection of rectal polyps - A case series.

Flexible systems in robotic transanal surgery (RTA) are a proposed solution to the challenges of transanal minimally invasive surgery (TAMIS). RTA was performed with the Medrobotics Flex® Robotics System to determine its safety and feasibility. Medrobotics Flex® Robotics System was used for transanal resection of benign rectal polyps by a single surgeon in a tertiary centre, and cases retrospectively reviewed. Five patients underwent flexible RTA, average age was 67years. Polyps were between 5 and 12 o'clock, mean distance of 8.3cm from the anal verge. Average operating time was 143min. There was no peri-operative or 30-day morbidity or mortality. Histopathology included tubulovillous adenoma (TVA), and one hyperplastic polyp, all were clear of the surgical margin. This is the first case series using Medrobotics Flex® Robotics System for RTA in a tertiary Australian public hospital. Flexible RTA is safe and feasible for the resection of benign rectal polyps.

Robotic Transanal Surgery for Rectal Cancer.

Robotic transanal surgery is the culmination of major developments in rectal cancer management and minimally invasive surgery. It is the result of continuous efforts to tackle the challenges inherent to rectal cancer surgery. This latest technology holds great promise and excitement for the care of the rectal cancer patient. In this article, we will describe the evolution of transanal rectal cancer surgery and describe how the convergence of transanal transabdominal, transanal endoscopic microsurgery, transanal minimally invasive surgery (TAMIS), transanal total mesorectal excision (taTME), and the different robotic platforms have culminated in the development of single port robotic transanal minimally invasive surgery (SP rTAMIS) and single port robotic transanal total mesorectal excision (SP rtaTME). We will describe the indications, technical aspects, outcomes, benefits, and limitations of the SP rTAMIS and SP rtaTME.

Robotic Transanal Surgery. Initial Experience in a Developing Country

Abstract Background Transanal minimally invasive surgery (TAMIS) is a surgical technique used for the excision of rectal neoplasia that gained popularity during the last decade.Due to the technical difficulty (non-articulated instruments, reduced workspace) and the long learning curve associated with this technique, the use of robotic platforms to improve resection results has been suggested and reported, at the same time that the learning curve decreases and the procedure is facilitated Materials and Methods From March 2017 to December 2019, all patients with rectal lesions eligible for TAMIS were offered the possibility to receive a robotic TAMIS (R-TAMIS). We used a transanal GelPoint Path (Applied Medical Inc., Santa Margarita, CA, USA) in the anal canal to be able to do the Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform docking, which we used to perform the excision of the rectal lesion as well as the resection site defect. Results Five patients between 34 and 79 years of age underwent R-TAMIS. The mean distance to the anal verge was 8.8 cm. There were no conversions. The mean surgery time was 85 minutes, and the mean docking time was 6.6 minutes. Conclusions Robotic TAMIS is a feasible alternative to TAMIS, with a faster learning curve for experienced surgeons in transanal surgery and better ergonomics. Further studies are needed to assess the cost-benefit relationship.

Robotic Transanal Surgery: A Novel Approach for Full-Thickness Rectal Excision.

Transanal excision of rectal lesions is a full thickness excision that is indicated in selected cases of early stage rectal cancer and in cases that have shown a major or complete clinical response after neoadjuvant chemoradiation. Complete clinical response includes also flat scar or teleangiectasia along with non palpable mass at digital exam and non visible lymphnodes at MRI.1 Full thickness excision is considered primarily as a radical excisionaI biopsy and it has the advantage (vs watch and wait approach) to provide a hystologic confirmation of the complete response. The excision of the tumor/scar and the suture of the rectal defect are technically demanding if performed with standard laparoscopic instruments because of the narrow working space. In order to overcome these difficulties we propose to use the daVinci® robotic platform. The robotic instruments are fully articulated at their tip and they allow the surgeon to easily operate within the lumen of the rectum and perform wrist like movements despite the narrow surgical space. The one limitation is represented by the cost of these procedures, so they should be reserved to selected, challenging cases (i.e. lesions of the mid-upper rectum and lesions that require extensive suture). The patients are either in lithotomy or prone position, depending on the site of the lesion. A gelpoint® system is inserted transanally in order to place the robotic trocars and the daVinci® system is then connected. The purpose of this video is to show the many advantages of the robotic platform in performing full thickness excisions and how the wrist like movements allow to perform transversal sutures thus minimizing the risk of stenosis of the rectum. See Video at http://links.lww.com/DCR/B515 .

Robotic transanal ressection for rectal tumor: A description of the technique

IntroductionRobotic transanal surgery (RTS) is the analog of TAMIS and represents a new focus for the advancement of transanal platforms robotic transanal surgery is sometimes referred to as robotic TAMIS. Though limited to only a few centers world-wide, experience with robotic transanal surgery has been encouraging. Most research with robotic transanal surgery has concentrated on local excision of rectal neoplasia, although more complex procedures such as transanal proctectomy are possible using the robotic approach. This article reports the surgical technique of R-TAMIS performed in the Brazilian National Cancer Institute (INCA, Rio de Janeiro). Methods71-year-old, female with cardiologic disease (heart failure), with a 1.5 cm rectal neoplasm at 4 cm from the anal verge in the right anterolateral position. Biopsy revealed neuroendocrine tumor. A compete colonoscopy revealed no evidence of synchronous lesions. Work-up included 3D endorectal ultrasonography and magnetic resonance imaging, which demonstrated the lesion to be uT1uN0. The patient was counseled about surgical options − local excision versus low anterior resection. Due to the cardiologic condition, the patient was elected to proceed with local excision with robotic transanal surgery. ConclusionRobotic TAMIS is a safe and effective operative procedure for high selected cases of rectal neoplasm. It enhances surgeon ergonomics and facilitates tumor removal and suture in the transanal approach.

Robotic transanal surgery: perspectives for application

Transanal minimally invasive surgery (TAMIS) is a surgical technique which allows the local excision of rectal benign tumors and early stage cancers measuring up to 4 cm and lying within 6-8 cm from the anal verge. It is performed by means of a disposable transanal platform and conventional laparoscopic instruments, proving to be effective and easily available. Hence, TAMIS soon became a valid alternative to other transanal resective procedures, especially transanal endoscopic microsurgery, and rapidly spread. Moreover, soon after its introduction, TAMIS started to be performed also using robotic technologies, but no clear advantages were found to date. This review is intended to provide a general overview on TAMIS, with a special focus on its association with robotic systems and the perspectives of this approach.

Robotic transanal palliation of rectal tumors in frail patients: How i do it?

Frail patients with malignant tumors of the rectum may be candidates for palliative robotic transanal surgery, given increased risks for perioperative morbidity and mortality. We, herein, described the surgical technique of robotic transanal surgery and attempted to provide readers with a concise insight into the current state of this procedure.

Review and update: robotic transanal surgery (RTAS).

As the field of surgery advances, new approaches have allowed surgeons additional flexibility to perform further interventions with minimal or no external incisions. For many years, single site access (SSA) has been used for transanal procedures, and platforms allowing modified endoscopic approaches have been available. These platforms have limitations related to access, visualization, dexterity, camera control, and instrumentation. Recently, surgical robotics companies have developed and introduced new technologies and platforms, which may help address some of these limitations. Comprehensive internet, open access, and medical and industry conference reviews of robotic surgery platforms and technology available for use in SSA surgery were conducted and 30 articles were found using keywords "robotic surgery, transanal, single site, robotic transanal surgery". A PubMed, Medline, Journals @OVID and open access search for data related to these platforms and technologies was also performed yielding 11 articles. Abstracts were reviewed for those written in the English language, leaving 40 articles which were then filtered for those pertaining to robotic surgery, transanal. 58 abstracts were found, duplicates were eliminated, and the remaining 35 articles were read in their entirety by two reviewers. Several new and existing platforms are identified for use in SSA surgery for transanal surgery as well as abdominal and transoral surgery. These are reviewed, including brand, features, approved and suggested uses, and potential limitations. New robotic technologies serve to enhance the ability of surgeons to perform SSA surgery. This next generation of robotic surgery technology overcomes some of the limitations of preceding endoscopic SSA surgery technology and will enhance the advancement of robotic transanal surgery, but outcomes and performance data are still limited.

Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution.

Robotic transanal surgery represents a natural evolution of transanal minimally invasive surgery. This new approach to rectal surgery provides the ability to perform local excision of rectal neoplasia with precision. Robotic transanal surgery can also be used to perform more advanced procedures including repair of complex fistulae and transanal total mesorectal excision. Data from patients who underwent transanal robotic surgery over a 33-month period were retrospectively reviewed. Patients underwent three types of procedures using this approach: (a) local excision of rectal neoplasia, (b) transanal total mesorectal excision, and (c) closure of complex fistulae, such as rectourethral fistulae. Eighteen patients underwent robotic transanal surgery during the 33-month study period. Of these, nine patients underwent local excision of rectal neoplasia; four patients underwent transanal total mesorectal excision; four patients underwent repair of rectourethral fistulae; and one patient underwent repair of an anastomotic fistula. Of the patients undergoing robotic transanal surgery for local excision, 6/9 were resections of benign neoplasia, while 3/9 were resections for invasive adenocarcinoma. There was no fragmentation (0/9) noted on any of the locally excised specimens, while one patient (1/9) had a positive lateral margin. During the mean follow-up of 11.4 months, no recurrence was detected. Four patients underwent robotic-assisted transanal total mesorectal excision for curative intent resection of rectal cancer confined to the distal rectum. Mesorectal quality was graded as complete or near complete, and an R0 resection was performed in all four cases. Other transanal robotic procedures performed were the repair of rectourethral fistulae (n = 3) and anastomotic fistula (n = 1). This approach was met with limited success, and only half of the rectourethral fistulae were closed. Robotic transanal surgery for local excision, transanal total mesorectal excision, and repair of fistulae is feasible, although these new approaches represent a work-in-progress. Improvement in platform design will likely facilitate the ability to perform more complex procedures. Further research with robotic transanal approaches is necessary to determine whether or not this approach can provide patients with significant benefit.

A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013.

Transanal minimally invasive surgery (TAMIS) was introduced as an alternative to transanal endoscopic microsurgery in 2010. Over the past 4years, considerable international experience has been gained with this approach. Most published reports focus on TAMIS for local excision of rectal neoplasia, but there are other important applications such as transanal mesorectal excision for rectal cancer. This comprehensive review details the progress with TAMIS since its inception. Robotic transanal surgery is a natural evolution of TAMIS still in its early infancy, which is also reviewed. A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Knowledge was performed. Since the inception of TAMIS in 2009, 33 retrospective studies and case reports, and 3 abstracts have been published on TAMIS for local excision of rectal neoplasms, which represents a combined n=390 TAMIS procedures performed worldwide using eight different types of TAMIS platforms. A total of 152 lesions were excised for benign disease including adenomas and high-grade dysplasias (39%), 209 for malignancy for carcinomas in situ and adenocarcinomas (53.5%). Twenty-nine (7.5%) of TAMIS resections were for other pathology, of which the majority (23/29) were neuroendocrine lesions. The remaining resections were for mucocele, gastrointestinal stromal tumor, melanoma, and fibrosis. Robotic-TAMIS has also been reported, however, data are extremely limited as there are only 7 case reports (combined n=11) in the published literature. Success with Robotic-TAMIS has been demonstrated with various patient positions and by use of a special glove port. Transanal total mesorectal excision using the TAMIS platform has also been demonstrated is several small series, and the feasibility of performing pure transanal total mesorectal excision has also been reported. Combined, n=78 cases of transanal total mesorectal excision have been performed using TAMIS. The advantages of TAMIS-assisted transanal total mesorectal excision are discussed.

Robotic transanal surgery for local excision of rectal neoplasms.

Robotic transanal surgery (RTS) has been a natural evolution of transanal minimally invasive surgery. This video demonstrates how RTS is performed for the full-thickness excision of a malignant rectal polyp, with endoluminal robotic suturing of the rectal wall defect. The general approach to RTS, including the approach to docking of the robotic cart, are also illustrated in video format.

Excision of a rectal neoplasm using robotic transanal surgery (RTS): a description of the technique

The approach to local excision of benign and early-stage, well-selected neoplasms of the rectum continues to evolve. We demonstrate here that local excision of a rectal neoplasm using the da Vinci Robotic Surgical System can be successfully performed. To our knowledge, this is the first time robotic transanal surgery (RTS) has been used in this manner.