Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal Neoplasia: Clinical Experience With 58 Consecutive Patients

BACKGROUND: Given the significant perioperative risks and costs of total mesorectal excision, minimally invasive transanal surgical approaches have grown in popularity for early rectal cancer and rectal polyps. This article discusses a transanal robotic surgery technique to perform full-thickness resections of benign and malignant rectal neoplasms. OBJECTIVE: The purpose of this study was to describe an initial experience with robotic transanal minimally invasive surgery. DESIGN: This was a retrospective cohort study of consecutive patients who underwent robotic transanal minimally invasive surgery. SETTINGS: The study was conducted at a high-volume colorectal surgery practice with a large health maintenance organization. PATIENTS: Patients at Southern California Kaiser Permanente with early rectal cancer and rectal polyps amenable to transanal excision were included. INTERVENTIONS: Transanal resection of rectal tumors were removed using robotic transanal minimally invasive surgery. MAIN OUTCOME MEASURES: Local recurrence of rectal pathology was measured. RESULTS: A total of 58 patients underwent robotic transanal minimally invasive surgery with full-thickness rectal resection by 4 surgeons for the following indications: rectal cancer (n = 28), rectal polyp (n = 18), rectal carcinoid (n = 11), and rectal GI stromal tumor (n = 1). Mean operative time was 66.2 minutes (range, 17–180 min). The mean tumor height from the anal verge was 8.8 cm (range, 4–14 cm), and the mean specimen size was 3.3 cm (range, 1.3–8.2 cm). A total of 57 (98.3%) of 58 specimens were intact, and 55 (94.8%) of 58 specimens had negative surgical margins. At a mean follow-up of 11.5 months (range, 0.3–33.3 mo), 3 patients (5.5%) developed local recurrences, and all underwent successful salvage surgery. LIMITATIONS: The study was limited by being a retrospective, nonrandomized trial with short follow-up. CONCLUSIONS: Robotic transanal minimally invasive surgery is a safe, oncologically effective surgical approach for rectal polyps and early rectal cancers. It offers the oncologic benefits and perioperative complication profile of other transanal minimally invasive surgical approaches but also enhances surgeon ergonomics and provides an efficient transanal rectal platform. See Video Abstract at http://bit.ly/2SBh1UF.

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