An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surge
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ORIGINAL ARTICLE
An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surgery Lino Polese 1 & Roberto Rizzato 1 & Andrea Porzionato 2 & Gianfranco Da Dalt 1 & Alice Bressan 1 & Raffaele De Caro 2 & Stefano Merigliano 1 Accepted: 14 May 2020 # The Author(s) 2020
Abstract Purpose The study aimed to evaluate the feasibility and safety of a new trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS) platform to treat rectal lesions. Methods ARAMIS was first compared with two transanal minimally invasive surgery platforms (SILS Port and GelPOINT Path) on human cadavers. Surgeons with different experience performed running sutures at different distances, at four quadrants, using the three platforms and gave a score to visibility, safety, and maneuverability. ARAMIS was then utilized on patients affected with rectal neoplasia who met the inclusion criteria. Patients and tumor characteristic and results were prospectively collected. The follow-up examinations included proctoscopy at 3, 6, and 12 months. Results According to surgeons’ scores, ARAMIS improves visibility and safety with respect to other platforms for distances beyond 10 cm. The procedure, which lasted an average of 59 min, was successfully carried out in 14 patients. No intraoperative or postoperative complications were reported. The mean tumor size was 3 cm; they were located a mean of 11 cm from the anal verge. Complete removal of the lesion was possible in 13/14 patients. There was one case of adenoma recurrence at follow-up. Conclusion Study results showed that ARAMIS, which is equipped with an adjustable rectoscope, can be considered a safe, effective platform for transanal surgery. The rectoscope protects the rectum during the procedure, a particularly important consideration when proximal rectal lesions are being treated. Further clinical studies are warranted to confirm these encouraging results. Keywords TEM . TAMIS . Rectal tumors
Introduction Transanal surgery for rectal cancer is feasible and widely accepted in early stages. According to National Comprehensive Cancer Network guidelines, transanal excision (TAE) can be performed if the lesion is smaller than 3 cm and there is less than 30% of bowel circumference involvement. In addition, the rectal tumor must be stage T1, mobile and non-fixed to the rectal wall, well to moderately differentiated, located within
* Lino Polese [email protected] 1
Department of Surgery, Oncology and Gastroenterology, Section of Surgery, University of Padova, Clinica Chirurgica 3^, Sesto Piano Policlinico, Via Giustiniani 2, 35128 Padova, Italy
2
Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
8 cm of the anal verge, and showing no evidence of lymphadenopathy on pretreatment imaging. A proper local excision should, according to guidelines and standard protocols, be full thickness with clear margins (more than 3 mm) [1]. The TAE technique, which is indicated in cases of earlystage rectal cancer,
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