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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(02): 163-167
DOI: 10.1055/s-0041-1726051
Original article

Robotic Transanal Surgery. Initial Experience in a Developing Country

Cirugía Robótica Transanal. Experiencia inicial en un País en Vías de Desarrollo
Montserrat Guraieb-Trueba 
1   Colorectal Surgery Department, Hospital Central Militar, CdMx, México
,
Juan Carlos Sánchez-Robles
2   Colorectal Surgery Department, Hospital San Ángel Inn, CdMx, México
,
Eduardo Navarro-Lara
3   Colorectal Surgery Department, Hospital Ángeles del Carmen, Guadalajara, Jal, México
,
Víctor Javier Herrera-Virrueta
1   Colorectal Surgery Department, Hospital Central Militar, CdMx, México
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Abstract

Background Transanal minimally invasive surgery (TAMIS) is a surgical technique used for the excision of rectal neoplasia that gained popularity during the last decade.Due to the technical difficulty (non-articulated instruments, reduced workspace) and the long learning curve associated with this technique, the use of robotic platforms to improve resection results has been suggested and reported, at the same time that the learning curve decreases and the procedure is facilitated

Materials and Methods From March 2017 to December 2019, all patients with rectal lesions eligible for TAMIS were offered the possibility to receive a robotic TAMIS (R-TAMIS). We used a transanal GelPoint Path (Applied Medical Inc., Santa Margarita, CA, USA) in the anal canal to be able to do the Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform docking, which we used to perform the excision of the rectal lesion as well as the resection site defect.

Results Five patients between 34 and 79 years of age underwent R-TAMIS. The mean distance to the anal verge was 8.8 cm. There were no conversions. The mean surgery time was 85 minutes, and the mean docking time was 6.6 minutes.

Conclusions Robotic TAMIS is a feasible alternative to TAMIS, with a faster learning curve for experienced surgeons in transanal surgery and better ergonomics. Further studies are needed to assess the cost-benefit relationship.

Resumo

Introdução A cirurgia transanal minimamente invasiva (TAMIS, na sigla em inglês) é uma técnica que se tornou popular na última década para a excisão local de neoplasias no reto. Devido à dificuldade técnica (instrumentos não articulados, espaço de trabalho reduzido) e à longa curva de aprendizado representada por essa técnica, o uso de plataformas robóticas para melhorar os resultados da ressecção tem sido sugerido e relatado, ao mesmo tempo em que a curva de aprendizado diminui e o procedimento é facilitado.

Materiais e Métodos De março de 2017 a dezembro de 2019, foi oferecida aos pacientes com lesões retais candidatos ao TAMIS a possibilidade de ressecção transanal robótica (R-TAMIS). Foi utilizada uma porta de acesso transanal GelPoint Path (Applied Medical Inc. Santa Margarita, CA, EUA), que foi introduzida no canal anal para posteriormente criar pneumoperitônio e realizar o acoplamento do sistema robótico Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, EUA) para realizar a ressecção e o fechamento do defeito por robótica.

Resultados Cinco pacientes entre 79 e 34 anos foram submetidos à R-TAMIS. A distância média à margem anal foi de 8,8 cm. Não houve conversões. O tempo cirúrgico médio foi de 85 minutos, e o tempo médio de acoplamento foi de 6,6 minutos.

Conclusões A R-TAMIS é uma alternativa à TAMIS convencional, com menor curva de aprendizado para cirurgiões experientes em cirurgia transanal minimamente invasiva e melhor ergonomia para ressecção e fechamento. Outros estudos são necessários para avaliar a relação custo-benefício.

Keywords

transanal surgery - robotic surgery - rectal cancer - minimally invasive - rectal polyps - TAMIS - R-TAMIS

Palavras-chave

cirurgia transanal - cirurgia robótica - câncer retal - invasão mínima - pólipos do reto - TAMIS - R-TAMIS


Publication History

Received: 13 July 2020

Accepted: 15 January 2021

Article published online:
24 May 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Tomassi MJ, Taller J, Yuhan R, Ruan JH, Klaristenfeld DD. Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal Neoplasia: Clinical Experience With 58 Consecutive Patients. Dis Colon Rectum 2019; 62 (03) 279-285
    CrossrefPubMedGoogle Scholar
  • 2 Izquierdo KM, Salem JF, Cha E, Unal E, Marks JH. Transanal Surgery: A History of taTME Ancestry. Clin Colon Rectal Surg 2020; 33 (03) 128-133
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Litynski GS. Profiles in laparoscopy: Mouret, Dubois, and Perissat: the laparoscopic breakthrough in Europe (1987-1988). JSLS 1999; 3 (02) 163-167
    PubMedGoogle Scholar
  • 4 Rao GV, Reddy DN, Banerjee R. NOTES: human experience. Gastrointest Endosc Clin N Am 2008; 18 (02) 361-370 , x
    CrossrefPubMedGoogle Scholar
  • 5 Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010; 24 (09) 2200-2205
    CrossrefPubMedGoogle Scholar
  • 6 Atallah S, Albert M, deBeche-Adams T, Larach S. Transanal minimally invasive surgery (TAMIS): applications beyond local excision. Tech Coloproctol 2012
    Google Scholar
  • 7 O'Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal endoscopic microsurgery for early rectal cáncer: a single-center experience. Dis Colon Rectum 2017; 60 (02) 152-160
    CrossrefPubMedGoogle Scholar
  • 8 Clancy C, Burke JP, Albert MR, O'Connell PR, Winter DC. Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum 2015; 58 (02) 254-261
    CrossrefPubMedGoogle Scholar
  • 9 Hompes R, Rauh SM, Ris F, Tuynman JB, Mortensen NJ. Robotic transanal minimally invasive surgery for local excision of rectal neoplasms. Br J Surg 2014; 101 (05) 578-581
    CrossrefPubMedGoogle Scholar
  • 10 Atallah SB, Albert MR, deBeche-Adams TH, Larach SW. Robotic transanal minimally invasive surgery in a cadaveric model. Tech Coloproctol 2011; 15 (04) 461-464
    CrossrefPubMedGoogle Scholar
  • 11 Atallah S, Martin-Perez B, Parra-Davila E. et al. Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution. Tech Coloproctol 2015; 19 (07) 401-410
    CrossrefPubMedGoogle Scholar
  • 12 Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. [Transanal endoscopic microsurgery]. Leber Magen Darm 1985; 15 (06) 271-279
    PubMedGoogle Scholar
  • 13 Lirici MM, Kanehira E, Melzer A, Schurr MO. The outburst age: how TEM ignited the MIS revolution. Minim Invasive Ther Allied Technol 2014; 23 (01) 1-4
    CrossrefPubMedGoogle Scholar
  • 14 Atallah S, Quinteros F, Martin-Perez B, Larach S. Robotic transanal surgery for local excision of rectal neoplasms. J Robot Surg 2014; 8 (02) 193-194
    CrossrefPubMedGoogle Scholar
  • 15 Atallah S, Parra-Davila E, DeBeche-Adams T, Albert M, Larach S. Excision of a rectal neoplasm using robotic transanal surgery (RTS): a description of the technique. Tech Coloproctol 2012; 16 (05) 389-392
    CrossrefPubMedGoogle Scholar
  • 16 Liu S, Suzuki T, Murray BW. et al. Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience. Surg Endosc 2019; 33 (02) 543-548
    CrossrefPubMedGoogle Scholar