Robotic-assisted transanal total mesorectal excision for rectal cancer: technique and results from a single institution
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ORIGINAL ARTICLE
Robotic‑assisted transanal total mesorectal excision for rectal cancer: technique and results from a single institution J. Ye1,2 · H. Shen1 · F. Li1 · Y. Tian1 · Y. Gao1 · S. Zhao1 · B. Liu1 · W. Tong1 Received: 10 February 2020 / Accepted: 3 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Total mesorectal excision (TME) has greatly reduced the local recurrence rate of rectal cancer after colorectal surgery. Transanal TME (TaTME) is potentially a suitable option for patients with mid and low rectal cancer. Robotic systems overcome the limitations of laparoscopic surgery. The aim of this study was to investigate the safety and feasibility of robotic-assisted transanal total mesorectal excision (RTaTME) in patients with rectal cancer. Methods The clinical data of patients who underwent RTaTME for rectal cancer between May 2017 and January 2020 were reviewed. The perioperative data and short-term outcomes of all the patients were retrospectively analysed. Last follow-up was in May 2020. Results A total of 13 patients had RTaTME during the 36-month study period. The median docking time was 18 (IQR 16–20) minutes, median transanal phase time was 95 (IQR 74–100) minutes, median total operation time was 240 (IQR 195–270) minutes, median estimated blood loss was 60 (IQR 50–100) ml, the median number of lymph nodes retrieved was 15 (IQR 13–16) and median length of postoperative hospital stay was 7 (IQR 6–10) days. There was no mortality. Three (23%) patients suffered a postoperative complication including one anastomotic leak and one prolonged ileus, none of them required any intervention. Patients were followed up for a median of 15 (IQR 11–18) months, and no local tumour recurrences, metastasis or deaths were reported. Conclusions Our preliminary results suggest that RTaTME for rectal cancer is feasible. This innovative approach may offer patients potential benefits—further studies are needed Keywords Rectal cancer · Robotic surgery · Transanal total mesorectal excision · Transanal surgery
Introduction Since Sylla et al. [1] first reported transanal total mesorectal excision (TaTME) via a transanal endoscopic microsurgery platform in combination with laparoscopy in 2010, TaTME has attracted much attention in the colorectal surgery community. Based on the published data, TaTME is potentially a suitable option for patients with mid or low rectal cancer, especially for obese males with a narrow pelvis [2, 3]. Jingwang Ye and Haode Shen contributed equally to this work. * W. Tong [email protected] 1
Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
Department of General Surgery, The People’s Hospital of Shapingba District, Chongqing 404000, China
2
However, TaTME requires the dissection of the mesorectum under a new bottom-up field view in a narrow space via a transanal minimally invasive surgery platform, which is technically challenging for surgeons. The angle limitation and difficulty of instrument operation are the mai
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