The outcomes of two robotic platforms performing transanal minimally invasive surgery for rectal neoplasia: a case series of 21 patients

• Published in: Journal of robotic surgery 2020-08, Vol.14 (4), p.573-578
• Main Authors: Paull, Jessie O., Graham, Ada, Parascandola, Salvatore A., Hota, Salini, Pudalov, Natalie, Arnott, Suzanne, Skancke, Matthew, Obias, Vincent
• Format: Article
• Language: English
• Subjects: Abdomen; Biopsy; Body mass index; Cancer; Colonoscopy; Colorectal cancer; Demographics; Endoscopy; FDA approval; Females; Laparoscopy; Learning curves; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Original Article; Patients; Pelvis; Rectum; Robotic surgery; Robotics; Robots; Surgeons; Surgery; Tumors; Urology
• ISSN: 1863-2483; 1863-2491
• DOI: 10.1007/s11701-019-01021-1

Colorectal cancer remains the third most common cancer effecting adults. Surgical guidelines recommend transanal excision of early rectal neoplasia up to 8 cm from the anal verge. A retrospective review of two novel approaches for transanal robotic local excision with R0 resections of rectal cancers which was, on average, higher than 8 cm. Twenty-one cases of robotic assisted transanal surgery for early stage disease (T0–T1, N0) were reviewed. The first 10 cases performed with the da Vinci ® Si robotic platform between 2013 and 2016, and the first 11 cases performed using the Flex ® Medrobotics platform between August 2017 and August 2018. The average distance from the anal verge was 11.1 cm and 9.5 cm for the da Vinci ® Si and Flex ® Colorectal Drive, respectively. The average operative time was 167.6 min for the da Vinci ® Si and 110.1 min for the Flex ® Colorectal Drive; the average EBL was 37.5 cc and 9.1 cc for the da Vinci ® Si and Flex ® Colorectal Drive. In the da Vinci ® series, four cases required intraoperative conversion. In the Flex ® series, one case was aborted due to unfavorable robotic positioning. All margins were histologically negative when surgically complete with no recurrences to date. Transanal robotic surgery may provide a method to address rectal lesions farther from the anal verge than previously described. The Flex ® Colorectal Drive platform may provide superior ability to navigate the nonlinear anatomy of the rectum and distal sigmoid colon.