Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
Dis Colon Rectum. 2013 Oct;56(10):1194-8. doi: 10.1097/DCR.0b013e3182a2ac84.
Transanal endoscopic microsurgery is a minimally invasive approach reserved for the resection of selected rectal tumors. However, this approach is technically demanding. Although robotic technology may overcome the limitations of this approach, the system can be difficult to dock, especially in the lithotomy position.
The study aim is thus to report the technical details of robotic transanal endoscopic microsurgery with the use of a lateral approach.
This study is a prospective evaluation of robotic transanal endoscopic microsurgery in a single tertiary institution, under a protocol approved by our local ethics committee.
Patients underwent a routine mechanical bowel preparation and were placed in the left or right lateral position according to the tumor location. A circular anal dilatator was used together with the glove port technique. The robotic system was then docked over the hip. A 30° optic and 2 articulated instruments were used with an additional assistant trocar. The tumor excision was realized with an atraumatic grasper and an articulated cautery hook, and the defect was closed with barbed continuous stiches in each case.
The primary outcome was the safety and feasibility of the procedure.
Three patients underwent a robotic transanal endoscopic microsurgery with the use of the lateral approach. Mean operative time was 110 minutes, including 20 minutes for the docking of the robot. There was 1 intraoperative complication (a pneumoperitoneum without intraabdominal lesion) and no postoperative complications. Mean hospital stay was 3 days. Margins were negative in all the cases.
The study was limited by the small number of patients.
Robotic transanal endoscopic microsurgery with use of the lateral approach is feasible and may facilitate the local resection of small lesions of the mid and lower rectum. It might assume an important place in sphincter-preserving surgery, especially for selected and early rectal cancer (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A114).
经肛门内镜微创手术是一种微创方法，专门用于切除选定的直肠肿瘤。然而，这种方法技术要求很高。尽管机器人技术可以克服该方法的局限性，但该系统可能难以对接，尤其是在截石位。
本研究旨在报告使用侧向入路进行机器人经肛门内镜微创手术的技术细节。
这是一项在一家三级医疗机构进行的机器人经肛门内镜微创手术的前瞻性评估，遵循我们当地伦理委员会批准的方案。
患者接受常规机械肠道准备，并根据肿瘤位置置于左侧或右侧侧卧位。使用圆形肛门扩张器和手套端口技术。然后将机器人系统对接在臀部上方。使用 30°光学镜和 2 个关节器械，并额外使用辅助 trocar。使用无创伤抓钳和关节电烙钩切除肿瘤，在每种情况下均使用带刺连续缝线关闭缺损。
主要结果是该程序的安全性和可行性。
有 3 名患者接受了使用侧向入路的机器人经肛门内镜微创手术。平均手术时间为 110 分钟，其中机器人对接用时 20 分钟。有 1 例术中并发症（气腹但无腹腔内损伤），无术后并发症。平均住院时间为 3 天。所有病例的切缘均为阴性。
该研究受到患者数量少的限制。
使用侧向入路的机器人经肛门内镜微创手术是可行的，并且可以促进中低位直肠小病变的局部切除。对于保肛手术，尤其是对选择的早期直肠癌，它可能具有重要地位（参见视频，补充数字内容 1，http://links.lww.com/DCR/A114）。
