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A Transabdominal Robotic Purse-String Suture Technique for Transanal Total Mesorectal Excision
Takuya Tokunaga1, Hideya Kashihara1, Jun Higashijima1
1Department of Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
Summary
Transanal total mesorectal excision (TaTME) surgery benefits from robotic assistance for creating purse-string sutures. Robot-assisted purse-string suturing in TaTME leads to more complete colorectal anastomoses compared to transanal methods.
Area of Science:
- Colorectal surgery
- Surgical oncology
- Robotic surgery
Background:
- Transanal total mesorectal excision (TaTME) is a key technique for rectal cancer surgery.
- Creating a distal purse-string suture is crucial for anastomosis integrity but technically challenging.
- Robotic assistance may enhance precision and ease of suturing in deep pelvic access.
Purpose of the Study:
- To evaluate the utility of transabdominal robotic purse-string suturing in TaTME.
- To compare robotic-assisted suturing with transanal suturing for anastomosis quality.
- To assess short-term surgical outcomes in patients undergoing TaTME with different suturing techniques.
Main Methods:
- A comparative study involving 27 patients undergoing TaTME for mid- or lower-rectal cancer.
- Patients were divided into two groups: transabdominal robotic purse-string suturing (Robot group, n=11) and transanal purse-string suturing (Transanal group, n=16).
- Outcomes measured included purse-string suturing time and the quality of the "donut" specimen after single stapling technique (SST) anastomosis.
Main Results:
- The Robot group showed a trend towards shorter purse-string suturing times (541±206s vs. 729±310s, P=.07).
- All patients in the Robot group achieved complete donuts with intact muscular layers after SST anastomosis.
- In contrast, 5 of 16 patients in the Transanal group had incomplete donuts requiring additional suturing (P=.04).
Conclusions:
- Transabdominal robotic purse-string suturing appears to simplify the suturing process in TaTME.
- Robotic assistance may improve the reliability and integrity of colorectal anastomosis.
- This technique shows promise for enhancing surgical outcomes in TaTME procedures.
