Comparing advanced platforms for local excision of rectal lesions

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Surgical oncology

Background:

• Transanal surgery enables organ preservation for select rectal lesions, avoiding radical surgery consequences.
• Transanal endoscopic microsurgery (TEM) set a standard for local excision with improved outcomes over traditional methods.
• Single-port robotic (SP r) platforms offer a novel approach to transanal surgery.

Purpose of the Study:

• To compare perioperative and pathologic outcomes of TEM and SP r surgery for rectal lesion excision.
• To evaluate the efficacy and safety of SP r platforms against the established TEM standard.

Main Methods:

• A retrospective review of patients undergoing local rectal lesion excision (1/2001-5/2022).
• Propensity score matching (1:1) to create comparable TEM and SP rTAMIS cohorts.
• Comparison of clinical, tumor-specific, and perioperative outcomes, including operative time, complications, and margin status.

Main Results:

• 50 patients per cohort with similar baseline characteristics.
• SP rTAMIS demonstrated significantly shorter operative times (104 min vs. 245 min) compared to TEM.
• SP rTAMIS showed significantly lower postoperative morbidity (9% vs. 20%) with comparable oncologic outcomes (margin positivity, piecemeal resection).

Conclusions:

• Single-port robotic surgery yields high-quality outcomes for rectal lesion excision, comparable to TEM.
• SP r platforms offer faster operative times and reduced postoperative morbidity.
• These findings support the expanding use of SP robotic platforms in transanal surgery.