Abstract
Colorectal cancer remains the third most common cancer effecting adults. Surgical guidelines recommend transanal excision of early rectal neoplasia up to 8 cm from the anal verge. A retrospective review of two novel approaches for transanal robotic local excision with R0 resections of rectal cancers which was, on average, higher than 8 cm. Twenty-one cases of robotic assisted transanal surgery for early stage disease (T0–T1, N0) were reviewed. The first 10 cases performed with the da Vinci® Si robotic platform between 2013 and 2016, and the first 11 cases performed using the Flex® Medrobotics platform between August 2017 and August 2018. The average distance from the anal verge was 11.1 cm and 9.5 cm for the da Vinci® Si and Flex® Colorectal Drive, respectively. The average operative time was 167.6 min for the da Vinci® Si and 110.1 min for the Flex® Colorectal Drive; the average EBL was 37.5 cc and 9.1 cc for the da Vinci® Si and Flex® Colorectal Drive. In the da Vinci® series, four cases required intraoperative conversion. In the Flex® series, one case was aborted due to unfavorable robotic positioning. All margins were histologically negative when surgically complete with no recurrences to date. Transanal robotic surgery may provide a method to address rectal lesions farther from the anal verge than previously described. The Flex® Colorectal Drive platform may provide superior ability to navigate the nonlinear anatomy of the rectum and distal sigmoid colon.
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Author V. Obias is a consultant for Intuitive Surgical and Medrobotics. Authors J. Paull, S. Parascandola, A. Graham, S. Hota, N. Pudalov, S. Arnott, and M Skancke declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee [The George Washington University Committee on Human Research, Institutional Review Board (IRB), FWA00005945] and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Chesapeake Colorectal Society, Arlington VA, April 13th, 2019.
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Paull, J.O., Graham, A., Parascandola, S.A. et al. The outcomes of two robotic platforms performing transanal minimally invasive surgery for rectal neoplasia: a case series of 21 patients. J Robotic Surg 14, 573–578 (2020). https://doi.org/10.1007/s11701-019-01021-1
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DOI: https://doi.org/10.1007/s11701-019-01021-1