Early experience with the ARTISENTIAL^® articulated instruments in laparoscopic low anterior resection with TME

The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL^® instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL^®.

Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIAL^® articulated instruments in performing a laparoscopic low anterior resection. Perioperative and short-term postoperative data were analyzed.

Seventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47-80 years) and a median body mass index of 28 kg/m² (range 23-33 kg/m²). The median time to rectal transection was 155 min (range 118-280 min) and the median total operative time was 276 min (range 192-458 min). The median estimated blood loss was 30 ml (range 5-70 ml) and there were no conversions to laparotomy. The median number of harvested lymph nodes was 15 (range 12-28). Total mesorectal excision (TME) quality was 'good' in all patients with no cases of circumferential resection margin involvement (R0 = 100%). The median length of stay was 9 days (range 7-14 days). There were no anastomotic leaks and the overall complication rate was 17.6%. There was one unrelated readmission with no mortality.

Low anterior resection with ARTISENTIAL^® is feasible and safe. All patients had a successful TME procedure with a good oncological outcome. We will now seek to evaluate the benefits of ARTISENTIAL^® in comparison with standard laparoscopic instruments through a larger study.