Robotic transanal minimally invasive surgery: a case series

Lo, Karina W.; Blitzer, David; Shoucair, Sami; Lisle, David M.

doi:10.1007/s00464-020-08257-1

Cited by 11 publications

(17 citation statements)

References 22 publications

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“…The youngest patient was 22 years old [ 33 ] and the oldest 88 years [ 16 ]. BMI was between 17.8 [ 28 ] and 43.4 kg/m 2 [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…The patients with a stage T2 and T3 adenocarcinoma were either staged T1 preoperatively ( n = 11), not interested in more radical surgery [ 25 , 34 ] or palliative [ 8 , 16 , 18 , 26 ]. Regarding the 11 patients with a wrong perioperative staging, they were offered more radical surgery (total mesorectal excision (TME) or LAR) and/or chemoradiation therapy [ 8 , 15 , 16 , 26 , 25 , 33 ]. The rest were 22 carcinoid/NET tumors [ 8 , 21 , 22 , 25 , 30 , 34 ], nine excisions with complete clinical-pathological response (ypT0) [ 27 , 33 , 34 ], six scar polypectomies [ 14 , 15 ], four GIST-tumors [ 25 , 27 , 34 ], four non-neoplasias [ 33 ], two rectal ulcers [ 30 ], and one submucosal leiomyoma [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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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.

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“…The youngest patient was 22 years old [ 33 ] and the oldest 88 years [ 16 ]. BMI was between 17.8 [ 28 ] and 43.4 kg/m 2 [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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“…In terms of patient positioning, our experience with R-TAMIS is similar to that of other authors. Case series of patients undergoing R-TAMIS for rectal lesions have described several advantages including better 3D visualization, improved surgeon ergonomics, and the ability to position the patient in a consistent position regardless of the tumor location [ 11 ]. This is due to the Da Vinci’s 7 degrees of freedom, which enable the circumferential resection of lesions regardless of patient positioning.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the robot aids in suturing high in the rectum as it does not ergonomically limit the surgeon at the console even though instrument movement may be somewhat restricted similar to TEM or L-TAMIS. Others have also advocated for the ability to reach very low-lying tumors due to the articulation of the wrist [ 11 ] although these lesions may not require any advanced instrumentation. None of our robot excisions required conversion to a different approach, a finding similar to the experience of others [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of advanced techniques for local excision of rectal lesions: a case series

et al. 2022

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Background Robotic transanal minimally invasive surgery (R-TAMIS) is an appealing alternative to transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) for benign and early malignant rectal lesions that are not amenable to traditional open transanal excision. However, no studies to our knowledge have directly compared the three techniques. This study sought to compare peri-operative and pathologic outcomes of the three approaches. Methods The records of 29 consecutive patients who underwent TEM, TAMIS, or R-TAMIS at a single academic center between 2016 and 2020 were reviewed. Intra-operative details, pathological diagnosis and margins, and post-operative outcomes were recorded. The three groups were compared using chi-square and Kruskal–Wallis tests. Results Overall, 16/29 patients were women and the median age was 57 (interquartile range (IQR): 28–81). Thirteen patients underwent TEM, six had TAMIS, and 10 had R-TAMIS. BMI was lower in the R-TAMIS patients (24.7; IQR 23.8–28.7), than in TEM (29.3; IQR 19.9–30.2), and TAMIS (30.4; IQR 26.6–32.9) patients. High grade dysplasia and/or invasive cancer was more common in TAMIS (80%) and R-TAMIS (66.7%) patients than in TEM patients (41.7%). The three groups did not differ significantly in tumor type or distance from the anal verge. No R-TAMIS patients had a positive surgical margin compared to 23.1% in the TEM group and 16.7% in the TAMIS group. Length of stay (median 1 day for TEM and R-TAMIS patients, 0 days for TAMIS patients) and 30-day readmission rates (7.7% of TEM, 0% of TAMIS, 10% of R-TAMIS patients) also did not differ among the groups. Median operative time was 110 min for TEM, 105 min for TAMIS, and 76 min for R-TAMIS patients. Conclusions R-TAMIS may have several advantages over other advanced techniques for transanal excisions. R-TAMIS tended to be faster and to more often result in negative surgical margins compared to the two other techniques.

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