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Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience

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Abstract

Background

Transanal minimally invasive surgery (TAMIS) offers intra-luminal full-thickness excision of rectal neoplasia. Robotic TAMIS (RT) allows for greater versatility in motion while operating in the limited space of the rectum. We present our experience with this technique in practice using the DaVinci Xi™ platform.

Method

This is a multi-institutional retrospective analysis for patient undergoing Robotic TAMIS for resection of rectal lesions at two tertiary referral hospitals in the United States. Morbidity, mortality, anatomic measurement, and final pathology were analyzed.

Results

Thirty-four patients planned for Robotic TAMIS were identified. Average follow-up was 188 days. The average BMI was 29.5 ± 5.9. All patients had an American Society of Anesthesiologist (ASA) Class of 2 or greater and 21 (62%) were ASA 3 or greater. Rectal lesions located from 2 to 15 cm from the dentate line were successfully resected. Lesions up to 4.5 cm in the longest dimension were successfully resected. The average operative time was 100 ± 70 min, which correlated to a robotic console time of 76 ± 67 min. Patients were placed in Lithotomy in 32 (94%) cases and were prone in only 2 (6%) cases. There were no intraoperative complications or conversions to another technique. The only postoperative complication was a medically managed Clostridium difficile infection in 1 patient. Three patients were upstaged to T2 on final pathology and underwent successful formal resections. BMI was a statistically significant predictor of a longer operation.

Conclusions

With increased reach and operative range of motion, Robotic TAMIS is a safe and effective method for excising low-risk rectal neoplasia with a wide range of anatomical measurements. Higher BMI is a significant predictor of a longer and likely more challenging operation.

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Authors and Affiliations

  1. University of California San Diego Healthcare Systems, La Jolla, CA, USA

    Shanglei Liu, Toshiaki Suzuki, Lisa Parry, Santiago Horgan, Sonia Ramamoorthy & Samuel Eisenstein

  2. Oklahoma Surgical Hospital, Tulsa, OK, USA

    Bryce W. Murray & Craig S. Johnson

  3. Center for the Future of Surgery, University of California at San Diego, 9500 Gilman Drive MC 0740, La Jolla, CA, 92093, USA

    Shanglei Liu

Authors
  1. Shanglei Liu
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  2. Toshiaki Suzuki
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  3. Bryce W. Murray
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  4. Lisa Parry
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  5. Craig S. Johnson
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  6. Santiago Horgan
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  7. Sonia Ramamoorthy
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  8. Samuel Eisenstein
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Contributions

Study conception and design—SL, TS, BWM, LP, CSJ, SH, SR, SE. Data acquisition and analysis—SL, TS, BWM, LP, CSJ, SH, SR, SE. Drafting or revising the article—SL, TS, BWM, LP, CSJ, SH, SR, SE. Final approval—SL, TS, BWM, LP, CSJ, SH, SR, SE. Agreement to be accountable for work—SL, TS, BWM, LP, CSJ, SH, SR, SE.

Corresponding author

Correspondence to Shanglei Liu.

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Disclosures

Drs. Shanglei Liu, Toshiaki Suzuki, Bryce W. Murray, Lisa Parry, Craig S. Johnson, Santiago Horgan, Sonia Ramamoorthy, and Samuel Eisenstein have no conflicts of interest or financial ties to disclose.

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Liu, S., Suzuki, T., Murray, B.W. et al. Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience. Surg Endosc 33, 543–548 (2019). https://doi.org/10.1007/s00464-018-6329-3

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  • DOI: https://doi.org/10.1007/s00464-018-6329-3

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