Clinical Experience of a Smart Articulating Digital Device For Transanal Minimally Invasive Surgery

Abstract

BACKGROUND: The constrained access associated with transanal minimally invasive surgery has led surgeons to deploy robotic-assisted platforms to offset inherent maneuverability limitations and, perhaps, skills deficits. IMPACT OF INNOVATION: A handheld, powered 5-mm lightweighted laparoendoscopic electromechanical digital device (HandX™, HumanXtensions, Israel) with hardware and software components that convert surgical hand movements precisely to the instrument’s articulating tip enabled robotic transanal minimally invasive surgery with its full roticulation for hook diathermy and suturing. TECHNOLOGY MATERIALS AND METHODS: After bench and biomedical model training, HandX™ was used in 3 transanal minimally invasive surgery procedures (2 male and 1 female patient, mean age 66.3 years). The rectal lesions averaged 30 mm in maximum dimension and were located posteriorly (n = 2) and laterally (n = 1) a mean of 3 cm from the anal verge. Standard transanal minimally invasive surgery setup and instrumentation (Gelport Path, Applied Medical with Airseal, Conmed) were used adding the HandX™ device for circumferential lesion marking and haemostatic full-thickness excision as well as defect suturing where appropriate. PRELIMINARY RESULTS: All procedures completed without undue prolongation (operating times <1 hour) despite nuisance hemorrhoidal bleeding in one. All lesions were fully excised with 2 proving to be T1 cancers and 1 tubullovillous adenoma with high-grade dysplasia. All patients were discharged within 48 hours postoperatively (one suffered secondary hemorrhage on postoperative day 5). CONCLUSIONS AND FUTURE DIRECTIONS: HandX− capably facilitated endoscopic robot-like instrument movement for transanal minimally invasive surgery without disrupting workflows. With time dedicated to instrument understanding and training, HandX− increased dexterity with small operating room footprint may be offering greater cost-effectiveness than other platforms.