Hans F Fuchs, MD1, Karl-Hermann Fuchs, MD2, Garth R Jacobsen3, Bryan J Sandler3, Santiago Horgan, MD3. 1Department of Surgery, University of Cologne, Germany, 2Department of Surgery, Markus Krankenhaus, Goethe University Frankfurt/Main, Germany, 3Center for the Future of Surgery, Department of Surgery, Division of Minimally
Reducing access size and trauma are important issues in the concept of natural orifice transluminal endoscopic surgery (NOTES). The combination of laparoscopic colorectal procedures and the NOTES concept resulted in the transanal approach of colorectal surgery. Transanal hybrid colon resection has been introduced into clinical practice with the goal of reduction of trocars and operative trauma. We investigate a novel transanal surgical platform with triangulating instruments especially developed for transanal surgery, permitting further reduction of abdominal trocars during transanal colon resection.
The FMX314 Surgical Platform for transanal colorectal surgery is currently a preclinical investigational device. It features articulating surgical instruments for the purpose of achieving triangulation after insertion through a multiple-use introducer with a diameter of currently 15mm. A feasibility study in an in vitro setting has been performed introducing the platform through a commercially available applicator for transanal surgery (TEA). Transanal surgery was performed with and without an additional transabdominal grasper or visual support. Feasibility of transanal approach for colon transection, suturing and range of the instruments were investigated.
Figure 1: FMX314 Surgical Platform, Instruments, and TEA Applicator
Figure 2: Operative Setting
Transanal colorectal surgery was feasible without as well as using only one additional laparoscopic instrument. Access to the abdominal cavity was performed 14-16 cm from the anus. The possible workspace ranged from 14-32 cm from the anus extraluminally as well as intraluminally with a wide range of motion. Surgical steps performed included colonic transection, and extra- and intraluminal suturing. Available instruments for the Platform included needle driver, Maryland, johan grasper, scissors, and hook knife.
Figure 3: Suturing using triangulation capabilities of the device
Figure 4: Range inside abdominal cavity
From this initial experience, transanal colon resection using the FMX314 Surgical Platform seems a feasible procedure that can be usefully introduced into clinical practice to ultimately eliminate abdominal trauma. Major benefits observed include excellent triangulation and range of motion. Design of an animal and cadaver trial is currently ongoing and planned for January 2016.