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Robotic transanal endoscopic microsurgery: technical details for the lateral approach
Nicolas C Buchs1, François Pugin, Francesco Volonte
1Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
Diseases of the Colon and Rectum
|September 12, 2013
Summary
Robotic transanal endoscopic microsurgery using a lateral approach is feasible for rectal tumors. This technique facilitates local resection and may be valuable in sphincter-preserving surgery for early rectal cancer.
Area of Science:
- Minimally invasive surgery
- Robotic surgery
- Colorectal surgery
Background:
- Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for rectal tumors but is technically demanding.
- Robotic technology offers potential to overcome TEM limitations, yet docking can be challenging, particularly in the lithotomy position.
Purpose of the Study:
- To detail the technical aspects of robotic transanal endoscopic microsurgery (R-TEM) utilizing a lateral approach.
- To evaluate the safety and feasibility of this novel R-TEM technique.
Main Methods:
- Prospective evaluation of R-TEM in a single tertiary institution.
- Patients positioned laterally; robotic system docked over the hip.
- Utilized a 30° optic, articulated instruments, and glove port technique for tumor excision and defect closure.
Main Results:
- Three patients successfully underwent R-TEM via the lateral approach.
- Mean operative time was 110 minutes (20 minutes for docking); one intraoperative pneumoperitoneum occurred without further complications.
- All cases achieved negative margins, with a mean hospital stay of 3 days.
Conclusions:
- Robotic transanal endoscopic microsurgery with a lateral approach is feasible and safe for selected rectal lesions.
- This technique may enhance local resection of mid and lower rectal tumors.
- It holds promise for sphincter-preserving surgery in early rectal cancer cases.
