ROBOTIC PLATFORM FOR TRANSANAL MINIMALLY INVASIVE SURGERY: A SINGLE INSTITUTIONAL EXPERIENCE
Nicolas Contreras*1, Monika Krezalek2, Kevin Behm2
1General Surgery, Mayo Clinic, Rochester, MN; 2Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
Background: Robotic transanal minimally invasive surgery (R-TAMIS) is a novel and evolving technique with limited reported outcomes in the literature. R-TAMIS provides enhanced optics, instruments with seven degrees of freedom, and easier maneuverability in the confines of the rectum when compared to traditional laparoscopic TAMIS. We report a single institution experience with R-TAMIS using the Da Vinci Xi platform.
Methods: A single institution retrospective analysis of patients undergoing R-TAMIS was performed. The preoperative diagnosis, patient demographics, anatomic measurements, complications and pathology were all recorded.
Results: From September 2017 to August 2018, 10 patients underwent R-TAMIS (7 purly robotic and 3 utilizing a hybrid technique). The average follow-up was 187 days (IQR 7-257). Five patients underwent R-TAMIS for large endoscopically unresectable rectal polyps, 2 for rectal adenocarcinoma, 2 for rectal gastrointestinal stromal tumor (GIST), and 1 for rectal carcinoid tumor. The median size of the lesions was 4.5 cm (IQR 2.2-6 cm), with the largest lesions successfully resected being a 13.5 cm x 4.8 cm nearly circumferential, flat, carpeting polyp. The median location of lesions was 7cm (IQR 6-8) from the anal verge. Resection margins were negative in 9 patients, with one patient having a focally positive margin for a rectal tubular adenoma with low grade dysplasia. The patient was followed endoscopically for 1 year without recurrence. The median operative time was 132 minutes (IQR 105-172). One patient experienced intra-operative hypotension after polyp resection. The patient was discharged on post-operative day 3 without any sequela. There were no 30-day complications or deaths. The median post-operative day of discharge was day 0 (IQR 0-1), where 60% of patients were discharged the same day of surgery.
Conclusions: R-TAMIS is a safe and effective method for excision of a variety of large, complex rectal lesions. We present our institutional experience with R-TAMIS, which shows the feasibility of this technique in the surgical treatment of large and nearly circumferential rectal pathology.
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