Atallah S, Martin-Perez B, Parra-Davila E, deBeche-Adams T, Nassif G, Albert M, Larach S
Florida Hospital, Winter Park, FL, USA,
Tech Coloproctol. 2015 Jul;19(7):401-10. doi: 10.1007/s10151-015-1283-8. Epub 2015 Feb 24.
Robotic transanal surgery represents a natural evolution of transanal minimally invasive surgery. This new approach to rectal surgery provides the ability to perform local excision of rectal neoplasia with precision. Robotic transanal surgery can also be used to perform more advanced procedures including repair of complex fistulae and transanal total mesorectal excision.
Data from patients who underwent transanal robotic surgery over a 33-month period were retrospectively reviewed. Patients underwent three types of procedures using this approach: (a) local excision of rectal neoplasia, (b) transanal total mesorectal excision, and (c) closure of complex fistulae, such as rectourethral fistulae.
Eighteen patients underwent robotic transanal surgery during the 33-month study period. Of these, nine patients underwent local excision of rectal neoplasia; four patients underwent transanal total mesorectal excision; four patients underwent repair of rectourethral fistulae; and one patient underwent repair of an anastomotic fistula. Of the patients undergoing robotic transanal surgery for local excision, 6/9 were resections of benign neoplasia, while 3/9 were resections for invasive adenocarcinoma. There was no fragmentation (0/9) noted on any of the locally excised specimens, while one patient (1/9) had a positive lateral margin. During the mean follow-up of 11.4 months, no recurrence was detected. Four patients underwent robotic-assisted transanal total mesorectal excision for curative intent resection of rectal cancer confined to the distal rectum. Mesorectal quality was graded as complete or near complete, and an R0 resection was performed in all four cases. Other transanal robotic procedures performed were the repair of rectourethral fistulae (n = 3) and anastomotic fistula (n = 1). This approach was met with limited success, and only half of the rectourethral fistulae were closed.
Robotic transanal surgery for local excision, transanal total mesorectal excision, and repair of fistulae is feasible, although these new approaches represent a work-in-progress. Improvement in platform design will likely facilitate the ability to perform more complex procedures. Further research with robotic transanal approaches is necessary to determine whether or not this approach can provide patients with significant benefit.
机器人经肛门手术是经肛门微创手术的自然演进。这种直肠手术的新方法能够精确地对直肠肿瘤进行局部切除。机器人经肛门手术还可用于实施更高级的手术，包括复杂肛瘘的修复及经肛门全直肠系膜切除术。
回顾性分析在33个月期间接受经肛门机器人手术的患者的数据。患者采用该方法接受了三种类型的手术：（a）直肠肿瘤局部切除术；（b）经肛门全直肠系膜切除术；（c）复杂肛瘘（如直肠尿道瘘）的闭合术。
在33个月的研究期间，18例患者接受了机器人经肛门手术。其中，9例患者接受了直肠肿瘤局部切除术；4例患者接受了经肛门全直肠系膜切除术；4例患者接受了直肠尿道瘘修复术；1例患者接受了吻合口瘘修复术。在接受机器人经肛门手术进行局部切除的患者中，6/9为良性肿瘤切除，而3/9为浸润性腺癌切除。在任何局部切除标本中均未发现破碎（0/9），而1例患者（1/9）切缘阳性。在平均11.4个月的随访期间，未检测到复发。4例患者接受机器人辅助经肛门全直肠系膜切除术，旨在对局限于直肠远端的直肠癌进行根治性切除。直肠系膜质量分级为完整或接近完整，所有4例均进行了R0切除。实施的其他经肛门机器人手术为直肠尿道瘘修复术（n = 3）和吻合口瘘修复术（n = 1）。该方法取得的成功有限，只有一半的直肠尿道瘘得以闭合。
机器人经肛门手术用于局部切除、经肛门全直肠系膜切除术及肛瘘修复是可行的，尽管这些新方法仍在不断完善中。平台设计的改进可能会促进实施更复杂手术的能力。有必要对机器人经肛门手术方法进行进一步研究，以确定该方法是否能为患者带来显著益处。
