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Asian J Surg. 2019 Jul 15. pii: S1015-9584(19)30286-6. doi: 10.1016/j.asjsur.2019.06.010. [Epub ahead of print]

Robotic transanal total mesorectal excision assisted by laparoscopic transabdominal approach: A preliminary twenty-case series report.

Author information

1
Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan.
2
Department of Surgery, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan.
3
College of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Colorectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
4
Department of Surgery, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan.
5
Department of Medicine, Division of Hospital Medicine, University of Pittsburgh Medical Center Shadyside Hospital, United States of America.
6
College of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Colorectal Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University Hospital, Yilan, Taiwan.
7
Department of Surgery, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: peter70.chen@me.com.

Abstract

BACKGROUND:

Laparoscopy-assisted robotic transanal total mesorectal excision is a novel surgical technique for rectal cancer resection. Compared to prior DaVinci Si system case series, this case series is the first to report robotic taTME assisted by laparoscopy (r-taTME) in which the "transanal team" operates via the DaVinci Xi system. As a result, we aim to delineate and discuss preliminary findings from our robotic taTME experiences.

METHODS:

A total of twenty patients (twelve males) who underwent robotic taTME assisted by laparoscopy (r-taTME) between January 2016 and November 2016 at a single institution were documented. Surgical outcomes, including complications, pathological outcomes, and short-term results, were then retrospectively analyzed.

RESULTS:

All patients underwent r-taTME via a two-team approach. The "abdominal team" operated via a single port method (ileostomy site), while the "transanal team" operated via the DaVinci Xi system. The mean patient age was 56.7 ± 14.3 years (range 31-79), and the mean distance from tumor to anal verge was 6.0 ± 2.7 cm (range 2-10). The mean estimated intraoperative blood loss was 88 ± 107 ml (range 30-500), and circular stapling was utilized to restore continuity in 80% of study patients. The overall postoperative complication rate was 35%, and the mean distal margin length was 3.1 ± 1.3 cm. There were three patients who had a circumferential margin (CRM) involved by cancer cells (≤1 mm).

CONCLUSION:

Our preliminary series report demonstrates that utilization of r-taTME assisted by laparoscopy is safe and feasible. Development of a novel transanal approach that allows single-port access alongside a multi-arm robotic system may increase the convenience and efficiency of future operation.

KEYWORDS:

DaVinci Xi; Rectal cancer; Robotic surgery; Robotic taTME; Transanal TME

PMID:
31320234
DOI:
10.1016/j.asjsur.2019.06.010
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