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International Journal of Colorectal Disease

, Volume 32, Issue 2, pp 249–254 | Cite as

Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery—initial experience with a new operation approach

  • Li-Jen Kuo
  • James Chi-Yong Ngu
  • Yiu-Shun Tong
  • Chia-Che Chen
Original Article

Abstract

Objective

Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery.

Methods

Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon. The clinical and pathological results were retrospectively analyzed.

Results

The median operative time was 473 (range, 335–569) min, and the estimated blood loss was 33 (range, 30–50) mL. The median number of lymph nodes harvested was 12 (range, 8–18). The median distal resection margin was 1.4 (range, 0.4–3.5) cm, and all patients had clear circumferential resection margins. We encountered a left ureteric transection intraoperatively in one patient, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality.

Conclusion

R-taTME followed by radical proctectomy using the R-SSPO technique for patients with low rectal lesions is technically feasible and safe without compromising oncologic outcomes. However, there were considerable limitations and a steep learning curve using current robotic technology.

Keywords

Rectal cancer Robotic surgery Single-site Transanal total mesorectal excision 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Sun S, Yang K, Gao M, He X, Tian J, Ma B (2009) Three-port versus four-port laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. World J Surg 33:1904–1908CrossRefPubMedGoogle Scholar
  2. 2.
    Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, Cheung HY, Lee KW (2003) Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc 17:1624–1627CrossRefPubMedGoogle Scholar
  3. 3.
    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695CrossRefPubMedGoogle Scholar
  4. 4.
    Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14–21CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–827CrossRefPubMedGoogle Scholar
  6. 6.
    Forgione A, Maggioni D, Sansonna F, Ferrari C, Di Lernia S, Citterio D, Magistro C, Frigerio L, Pugliese RJ (2008) Transvaginal endoscopic cholecystectomy in human beings: preliminary results. J Laparoendosc Adv Surg Tech A 18:345–351CrossRefPubMedGoogle Scholar
  7. 7.
    Sylla P, Willingham FF, Sohn DK, Gee D, Brugge WR, Rattner DW (2008) NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg 12:1717–1723CrossRefPubMedGoogle Scholar
  8. 8.
    Telem DA, Han KS, Kim MC, Ajari I, Sohn DK, Woods K, Kapur V, Sbeih MA, Perretta S, Rattner DW, Sylla P (2013) Transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) with total mesorectal excision in a large human cadaver series. Surg Endosc 27:74–80CrossRefPubMedGoogle Scholar
  9. 9.
    Tuech JJ, Bridoux V, Kianifard B, Schwarz L, Tsilividis B, Huet E, Michot F (2011) Natural orifice total mesorectal excision using transanal port and laparoscopic assistance. Eur J Surg Oncol 37:334–335CrossRefPubMedGoogle Scholar
  10. 10.
    Zorron R, Phillips HN, Coelho D, Flach L, Lemos FB, Vassallo RC (2012) Perirectal NOTES access: “down-to-up” total mesorectal excision for rectal cancer. Surg Innov 19:11–19CrossRefPubMedGoogle Scholar
  11. 11.
    Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221:415–423CrossRefPubMedGoogle Scholar
  12. 12.
    Ballantyne GH (2002) Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc 16:1389–1402CrossRefPubMedGoogle Scholar
  13. 13.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz JB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525CrossRefPubMedGoogle Scholar
  14. 14.
    Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188:19S–26SCrossRefPubMedGoogle Scholar
  15. 15.
    Lee SH, Jung MJ, Hwang HK, Kang CM, Lee WJ (2015) The first experiences of robotic single-site cholecystectomy in Asia: a potential way to expand minimally-invasive single-site surgery? Yonsei Med J 56:189–195CrossRefPubMedGoogle Scholar
  16. 16.
    Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P, Kaouk J, Chalikonda S (2011) First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci single-site platform. Surg Endosc 25:3566–3573CrossRefPubMedGoogle Scholar
  17. 17.
    Lewis EI, Srouji SS, Gargiulo AR (2015) Robotic single-site myomectomy: initial report and technique. Fertil Steril 103:1370–1377CrossRefPubMedGoogle Scholar
  18. 18.
    Pluchino N, Litta P, Freschi L, Russo M, Simi G, Santoro AN, Angioni S, Gadducci A, Cela V (2014) Comparison of the initial surgical experience with robotic and laparoscopic myomectomy. Int J Med Robot 10:208–212CrossRefPubMedGoogle Scholar
  19. 19.
    White MA, Autorino R, Spana G, Hillyer S, Stein RJ, Kaouk JH (2012) Robotic laparoendoscopic single-site urological surgery: analysis of 50 consecutive cases. J Urol 187:1696–1701CrossRefPubMedGoogle Scholar
  20. 20.
    Lee JW, Arconcel FR, Rha KH et al (2011) Urologic robot-assisted laparoendosopic single-site surgery using a homemade single-port device: a single-center experience of 68 cases. J Endourol 25:1481–1485CrossRefGoogle Scholar
  21. 21.
    Stein RJ, White WM, Goel RK, Irwin BH, Haber GP, Kaouk JH (2010) Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol 57:132–137CrossRefPubMedGoogle Scholar
  22. 22.
    Whiteford MH, Denk PM, Swanström LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21:1870–1874CrossRefPubMedGoogle Scholar
  23. 23.
    Fajardo AD, Hunt SR, Fleshman JW, Mutch MG (2010) Video. Transanal single-port low anterior resection in a cadaver model. Surg Endosc 24:1765CrossRefPubMedGoogle Scholar
  24. 24.
    Bhattacharjee HK, Kirschniak A, Storz P, Wilhelm P, Kunert W (2011) Transanal endoscopic microsurgery-based transanal access for colorectal surgery: experience on human cadavers. J Laparoendosc Adv Surg Tech A 21:835–840CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang H, Zhang YS, Jin XW, Li MZ, Fan JS, Yang ZH (2013) Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol 17:117–123CrossRefPubMedGoogle Scholar
  26. 26.
    Leroy J, Barry BD, Melani A, Mutter D, Marescaux J (2013) No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. JAMA Surg 148:226–230CrossRefPubMedGoogle Scholar
  27. 27.
    Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy AM, Rattner DW (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 27:3396–3405CrossRefPubMedGoogle Scholar
  28. 28.
    Chouillard E, Chahine E, Khoury G, Vinson-Bonnet B, Gumbs A, Azoulay D, Abdalla E (2014) NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc 28:3150–3157CrossRefPubMedGoogle Scholar
  29. 29.
    Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 18:473–480CrossRefPubMedGoogle Scholar
  30. 30.
    Verheijen PM, Consten EC, Broeders IA (2014) Robotic transanal total mesorectal excision for rectal cancer: experience with a first case. Int J Med Robot 10:423–426CrossRefPubMedGoogle Scholar
  31. 31.
    Gómez Ruiz M, Parra IM, Palazuelos CM, Martín JA, Fernández CC, Diego JC, Fleitas MG (2015) Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon rectum 58:145–153Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Li-Jen Kuo
    • 1
    • 2
    • 3
  • James Chi-Yong Ngu
    • 4
  • Yiu-Shun Tong
    • 5
  • Chia-Che Chen
    • 5
  1. 1.Division of Colorectal Surgery, Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan
  2. 2.Graduate Institute of Clinical Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  4. 4.Department of SurgeryChangi General HospitalSingaporeSingapore
  5. 5.Division of Acute Care Surgery and Traumatology, Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan

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