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. 2024 Jun;38(6):3368-3377.
doi: 10.1007/s00464-024-10829-4. Epub 2024 May 6.

Robotic transanal minimally invasive surgery (r-TAMIS): perioperative and short-term outcomes for local excision of rectal cancers

Guglielmo Niccolò Piozzi  1 , Ania Przedlacka  1 , Rauand Duhoky  1 , Oroog Ali  1   2 , Yasser Ghanem  3 , Richard Beable  4 , Antony Higginson  4 , Jim S Khan  5   6
Affiliations

Robotic transanal minimally invasive surgery (r-TAMIS): perioperative and short-term outcomes for local excision of rectal cancers

Guglielmo Niccolò Piozzi et al. Surg Endosc. 2024 Jun.

Abstract

Background: Transanal minimally invasive surgery (TAMIS) is an advanced technique for excision of early rectal cancers. Robotic TAMIS (r-TAMIS) has been introduced as technical improvement and potential alternative to total mesorectal excision (TME) in early rectal cancers and in frail patients. This study reports the perioperative and short-term oncological outcomes of r-TAMIS for local excision of early-stage rectal cancers.

Methods: Retrospective analysis of a prospectively collected r-TAMIS database (July 2021-July 2023). Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated.

Results: Twenty patients were included. Median age and body mass index were 69.5 (62.0-77.7) years and 31.0 (21.0-36.5) kg/m2. Male sex was prevalent (n = 12, 60.0%). ASA III accounted for 66.7%. Median distance from anal verge was 7.5 (5.0-11.7) cm. Median operation time was 90.0 (60.0-112.5) minutes. Blood loss was minimal. There were no conversions. Median postoperative stay was 2.0 (1.0-3.0) days. Minor and major complication rates were 25.0% and 0%, respectively. Seventeen (85.0%) patients had an adenocarcinoma whilst three patients had an adenoma. R0 rate was 90.0%. Most tumours were pT1 (55.0%), followed by pT2 (25.0%). One patient (5.0%) had a pT3 tumour. Specimen and tumour maximal median diameter were 51.0 (41.0-62.0) mm and 21.5 (17.2-42.0) mm, respectively. Median specimen area was 193.1 (134.3-323.3) cm2. Median follow-up was 15.5 (10.0-24.0) months. One patient developed local recurrence (5.0%).

Conclusions: r-TAMIS, with strict postoperative surveillance, is a safe and feasible approach for local excision of early rectal cancer and may have a role in surgically unfit and elderly patients who refuse or cannot undergo TME surgery. Future prospective multicentre large-scale studies are needed to report the long-term oncological outcomes.

Keywords: Rectal cancer; Robotic surgery; Robotic transanal surgery; TAMIS; Total mesorectal excision.

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Conflict of interest statement

Jim Khan performs proctoring for Intuitive Surgical and educational activity with Johnson & Johnson. Guglielmo Niccolò Piozzi, Ania Przedlacka, Rauand Duhoky, Oroog Ali, Yasser Ghanem, Richard Beable, and Tony Higginson have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
A Scheme of patient positioning and theatre configuration; An: anesthetist: As: assistant surgeon; Pc: patient cart; Sn: scrub nurse; St: scrub nurse table. B Port placement through a GelPOINT. C Patient cart docking position. D, E, F Surgical steps. G Specimen on oriented and pinned on a polystyrene sheet before fixation (yellow dotted line shows the tumor margin)
Fig. 2
Fig. 2
Kaplan–Meier survival curves for A overall survival and B disease-free survival of r-TAMIS
See this image and copyright information in PMC

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