SINGLE-PORT ROBOTIC SUBMUCOSAL DISSECTION FOR RECTAL POLYPS: FIRST 10 CASES AND INITIAL EXPERIENCE
Ilker Ozgur, David Liska, Stefan D. Holubar, Michael Valente, Scott Steele, Emre Gorgun*
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
Background
As endoluminal surgery gains momentum, semiflexible robotic platforms may enable and facilitate submucosal dissection for rectal lesions. We aim to present our initial experience of robotic submucosal dissections in rectal polyps with single-port robot.
Methods
We analyzed data of patients with rectal polyps who underwent robotic submucosal dissection with DaVinci Single Port robot between January 2020 and August 2021 at Cleveland Clinic. The primary endpoints were feasibility and short-term outcomes of the procedures.
Results
Ten consecutive patients with rectal polyps underwent robotic submucosal dissection with the single-port platform (Figure). The median age of the patients was 68 (range: 59-78) years, and 80% were male with a median BMI of 28 (range:23-38) kg/m2. The median surgery time was 96 (range:57-137) minutes, and lesion size was 40 (range:20-65) mm. All resected specimens were en-bloc. No immediate complication was observed, and all patients were discharged the same day. Late bleeding was observed in one patient who had been on anticoagulation medication, and one patient had urinary retention within 30 days of the procedure. Pathology revealed 2(20%) adenocarcinoma pT1, 6(60%) tubulovillous adenoma, 1(10%) tubular adenoma and 1(10%) sessile serrated adenoma. The first patients with adenocarcinoma also had LVI and underwent proctectomy. The pathology revealed stage II (pT1N1; 1/19 lymph nodes) rectal cancer. The other patient with adenocarcinoma had clear margins and has been on surveillance with no recurrence for 7 months. There was no recurrence in all other patients during the median follow-up of 6 months (range: 4-16 months).
Conclusions
A single-port robotic submucosal dissection is feasible for rectal polyps with acceptable perioperative and short-term outcomes. The semiflexible platform offers an alternative to endoscopic submucosal dissection and may be the next step for fully-flexible robotic dissections.
Figure. Single port robot docked for robotic rectal submucosal dissection.
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