PMID- 30451744
OWN - NLM
STAT- MEDLINE
DCOM- 20190502
LR  - 20190502
IS  - 1530-0358 (Electronic)
IS  - 0012-3706 (Linking)
VI  - 62
IP  - 3
DP  - 2019 Mar
TI  - Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal
      Neoplasia: Clinical Experience With 58 Consecutive Patients.
PG  - 279-285
LID - 10.1097/DCR.0000000000001223 [doi]
AB  - BACKGROUND: Given the significant perioperative risks and costs of total
      mesorectal excision, minimally invasive transanal surgical approaches have grown 
      in popularity for early rectal cancer and rectal polyps. This article discusses a
      transanal robotic surgery technique to perform full-thickness resections of
      benign and malignant rectal neoplasms. OBJECTIVE: The purpose of this study was
      to describe an initial experience with robotic transanal minimally invasive
      surgery. DESIGN: This was a retrospective cohort study of consecutive patients
      who underwent robotic transanal minimally invasive surgery. SETTINGS: The study
      was conducted at a high-volume colorectal surgery practice with a large health
      maintenance organization. PATIENTS: Patients at Southern California Kaiser
      Permanente with early rectal cancer and rectal polyps amenable to transanal
      excision were included. INTERVENTIONS: Transanal resection of rectal tumors were 
      removed using robotic transanal minimally invasive surgery. MAIN OUTCOME
      MEASURES: Local recurrence of rectal pathology was measured. RESULTS: A total of 
      58 patients underwent robotic transanal minimally invasive surgery with
      full-thickness rectal resection by 4 surgeons for the following indications:
      rectal cancer (n = 28), rectal polyp (n = 18), rectal carcinoid (n = 11), and
      rectal GI stromal tumor (n = 1). Mean operative time was 66.2 minutes (range,
      17-180 min). The mean tumor height from the anal verge was 8.8 cm (range, 4-14
      cm), and the mean specimen size was 3.3 cm (range, 1.3-8.2 cm). A total of 57
      (98.3%) of 58 specimens were intact, and 55 (94.8%) of 58 specimens had negative 
      surgical margins. At a mean follow-up of 11.5 months (range, 0.3-33.3 mo), 3
      patients (5.5%) developed local recurrences, and all underwent successful salvage
      surgery. LIMITATIONS: The study was limited by being a retrospective,
      nonrandomized trial with short follow-up. CONCLUSIONS: Robotic transanal
      minimally invasive surgery is a safe, oncologically effective surgical approach
      for rectal polyps and early rectal cancers. It offers the oncologic benefits and 
      perioperative complication profile of other transanal minimally invasive surgical
      approaches but also enhances surgeon ergonomics and provides an efficient
      transanal rectal platform. See Video Abstract at http://links.lww.com/DCR/A759.
FAU - Tomassi, Marco J
AU  - Tomassi MJ
AD  - Kaiser Permanente, Department of General Surgery, San Diego, California.
FAU - Taller, Janos
AU  - Taller J
AD  - Kaiser Permanente, Department of General Surgery, San Diego, California.
FAU - Yuhan, Robert
AU  - Yuhan R
AD  - Kaiser Permanente, Department of Colorectal Surgery, Fontana, California.
FAU - Ruan, Joseph H
AU  - Ruan JH
AD  - Kaiser Permanente, Department of Colorectal Surgery, Fontana, California.
FAU - Klaristenfeld, Daniel D
AU  - Klaristenfeld DD
AD  - Kaiser Permanente, Department of General Surgery, San Diego, California.
LA  - eng
PT  - Journal Article
PT  - Video-Audio Media
PL  - United States
TA  - Dis Colon Rectum
JT  - Diseases of the colon and rectum
JID - 0372764
SB  - IM
MH  - Anal Canal/*surgery
MH  - California/epidemiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Margins of Excision
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures
MH  - *Neoplasm Recurrence, Local/epidemiology/pathology/surgery
MH  - Neoplasm Staging
MH  - Operative Time
MH  - Outcome Assessment (Health Care)
MH  - Postoperative Complications
MH  - *Proctectomy/adverse effects/instrumentation/methods
MH  - *Rectal Neoplasms/pathology/surgery
MH  - Retrospective Studies
MH  - *Robotic Surgical Procedures/adverse effects/methods
EDAT- 2018/11/20 06:00
MHDA- 2019/05/03 06:00
CRDT- 2018/11/20 06:00
PHST- 2018/11/20 06:00 [pubmed]
PHST- 2019/05/03 06:00 [medline]
PHST- 2018/11/20 06:00 [entrez]
AID - 10.1097/DCR.0000000000001223 [doi]
PST - ppublish
SO  - Dis Colon Rectum. 2019 Mar;62(3):279-285. doi: 10.1097/DCR.0000000000001223.