First clinical experience with single-port robotic transanal minimally invasive surgery (SP rTAMIS) for benign rectal ne
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ORIGINAL ARTICLE
First clinical experience with single‑port robotic transanal minimally invasive surgery (SP rTAMIS) for benign rectal neoplasms J. H. Marks1 · E. Kunkel1 · J. F. Salem1 · C. Martin1 · B. Anderson1 · S. Agarwal1 Received: 14 September 2020 / Accepted: 6 October 2020 © Springer Nature Switzerland AG 2020
Abstract Background The new da Vinci Single-Port (SP) robot is a single-arm four-channel robotic system well suited for endoluminal surgery. We report our initial experience performing SP robotic transanal minimally invasive surgery (SP rTAMIS) for rectal neoplasms. Methods Under Institutional Review Board approval, two patients with rectal neoplasms were prospectively enrolled for elective SP rTAMIS. The primary endpoint was to report the safety and feasibility of successful procedure completion with the SP robot. Secondary endpoints included patient characteristics and perioperative metrics. Results Both patients underwent successful SP rTAMIS resection of rectal neoplasms without intraoperative complications or conversions. The lesions were 4.0 cm and 3.0 cm in size, located 6 cm and 7 cm cephalad to the anorectal ring. Excisions were full thickness with no piecemeal extractions or specimen fragmentation. Estimated blood loss was 0 mL and 30 mL. The mean excised area was 13.4 cm2 (22.7 cm2 and 9.0 cm2). The mean docking time was 5.25 min (range 2–8 min) and mean console time was 122.5 min (98 min and 147 min). Patients tolerated a liquid diet on postoperative day (POD) 0 and were discharged on POD 1 after tolerating a low residue diet and having bowel function. Pathology showed two adenomas with negative margins. There was no immediate or delayed morbidity or mortality. Conclusions Our initial experience indicates that SP rTAMIS is a safe and feasible approach for local excision of rectal lesions. While SP rTAMIS is very promising, more experience with this approach is necessary to determine its widespread applicability. Keywords Local excision · Transanal surgery · Transanal endoscopic microsurgery (TEM) · Transanal minimally invasive surgery (TAMIS) · Robotic surgery · Single-port robot (SP)
Introduction * J. H. Marks [email protected]; [email protected] E. Kunkel [email protected] J. F. Salem [email protected] C. Martin [email protected] B. Anderson [email protected] S. Agarwal [email protected] 1
Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Lankenau Medical Center, Medical Science Building, Suite 375, 600 East Lancaster Avenue, Wynnewood, PA 19096, USA
Transanal resection of benign and malignant rectal neoplasms presents an operative challenge to surgeons. The cephalad aspect of the lesion is often difficult to reach transanally without fragmentation or compromising the margins of the specimen. Many technological advances have been developed to improve reach, exposure, and ease of transanal rectal surgery. In 1983 Dr. Gerhard Buess developed transanal endoscopic microsurgery (TEM) that used a rigid transanal platform with insuffl
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