Robot-assisted TAMIS: a systematic review of feasibility and outcomes

Abstract

Background In the advancement of transanal local excision, robot-assisted transanal minimal invasive surgery is the newest development. In the confined area of the rectum, robot-assisted surgery should, theoretically, be superior due to articulated utensils, video enhancement, and tremor reduction, however, this has not yet been investigated. The aim of this study was to review the evidence reported to-date on experience of using robot-assisted transanal minimal invasive surgery for treatment of rectal neoplasms. Methods A comprehensive literature search of Embase and PubMed from May to August 2021were performed. Studies including patients diagnosed with rectal neoplasia or benign polyps who underwent robot-assisted transanal minimal invasive surgery were included. All studies were assessed for risk of bias through assessment tools. Main outcome measures were feasibility, excision quality, and complications. Results Twenty-five studies with a total of 322 local excisions were included. The studies included were all retrospective, primarily case-reports, -series, and cohort studies. The median distance from the anal verge ranged from 3.5 to 10 cm and the median size was between 2.5 and 5.3 cm. Overall, 4.6% of the resections had a positive resection margin. The overall complication rate was at 9.5% with severe complications (Clavien–Dindo score III) at 0.9%. Conclusion Based on limited, retrospective data, with a high risk of bias, robot-assisted transanal minimal invasive surgery seems feasible and safe for local excisions in the rectum. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09853-z.

Robotic transanal minimally invasive surgery (r-TAMIS): perioperative and short-term outcomes for local excision of rectal cancers

“…In the present series 90% of patients had an R0 resection with two patients having a deep margin involved (< 1 mm). This shows that extending the indication beyond the 3 cm limit indicated by the NCCN guidelines [ 27 ] can be considered safe as proposed by other studies, therefore, tumour dimension should not necessarily be considered a contraindication [ 10 ].…”

“…r-TAMIS allows for extending the height of dissection as shown in the current study with a median distance from the AV of 7.5 (5.0–11.7) cm and a maximal height of 15 cm. This allows the surgeon to expand the indication of transanal excision to the upper rectum and sigmoid which could further benefit from the use of endoscopic robotic platforms as the Flex® Colorectal Drive Robotic System (Medrobotics Corporation, Raynham, MA, USA) [ 10 , 37 ].…”

“…The introduction of transanal minimal invasive surgery (TAMIS) has optimized the transanal accessibility to rectal cancers allowing to excise also voluminous tumours even in the upper rectum [ 10 ]. TAMIS benefits from the use of standard laparoscopic instruments (no need for a specific platform), the transferability of operating skills from standard laparoscopy, the independency from a lesion-dependent positioning (specific of TEM) leading to faster setup, and use of the lithotomy position with ease of performing an abdominal access in case of need [ 11 ].…”

“…r-TAMIS has been used for less than a decade and its feasibility has been demonstrated in cadaveric models [ 14 ] and surgical series on benign and malignant tumours. However, large descriptive series (above ten cases) are still limited, especially on rectal cancers [ 10 , 15 – 18 ]. Moreover, small studies comparing laparoscopic to robotic TAMIS found no significant differences other than the total direct cost between the two approaches [ 19 ].…”

Initial Clinical Experience with Single-port Robotic Transanal Minimally Invasive Surgery for Rectal Cancer Running head: Single-port robotic transanal minimally invasive surgery for rectal cancer

“…In their study, the most frequent complication was peritoneal entry (2.1%); postoperative bleeding was reported in six (1.9%) patients, where three (0.9%) required endoscopic therapy [6, [10][11][12][13]. In particular, a prior study reported wound dehiscence in patients who received neoadjuvant chemoradiation [6].…”