Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience
| Autor: | Santiago Horgan, Lisa Parry, Craig S. Johnson, Bryce W Murray, Shanglei Liu, Toshiaki Suzuki, Samuel Eisenstein, Sonia Ramamoorthy |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer Operative Time Rectum Body Mass Index 03 medical and health sciences 0302 clinical medicine Postoperative Complications Robotic Surgical Procedures Medicine Anal cancer Humans Robotic surgery Aged Retrospective Studies Transanal Endoscopic Surgery Analysis of Variance business.industry Rectal Neoplasms Postoperative complication Middle Aged medicine.disease Lithotomy position Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female Range of motion business Abdominal surgery |
| Zdroj: | Surgical endoscopy. 33(2) |
| ISSN: | 1432-2218 |
| Popis: | 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. 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. 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. 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. |
| Databáze: | OpenAIRE |
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