Sung G Lee, MD, Andrew Russ, MD, FACS, FASCRS, Mark Casillas, Jr., MD, FACS, FASCRS. University of Tennessee Medical Center at Knoxville
Introduction: Transanal minimally invasive surgery (TAMIS) has gained worldwide popularity as a method for the local excision of rectal neoplasms. However, it is technically demanding due to limited working space. Robotic TAMIS offers enhanced dexterity and ability while allowing for a more aggressive resection with a stable platform. The objective of this study was to review a single institution experience between laparoscopic (L-TAMIS) and robotic TAMIS (R-TAMIS) for treatment of rectal neoplasms and determine if there are significant differences on outcomes.
Methods: From January 2012 to April 2017, 41 consecutive patients with rectal neoplasms underwent L-TAMIS or R-TAMIS by two colorectal surgeons. We retrospectively reviewed a prospectively maintained database to analyze demographics, perioperative data, pathology, and postoperative complications, and cost.
There was no significant difference between L- and R-TAMIS on patient demographics.
R-TAMIS showed a statically significant increase in cost of surgery by $880. Wider range of total duration for L-TAMIS is likely due to the variability of body habitus and location of rectal neoplasm, which can significantly limit L-TAMIS compare to R-TAMIS.
One L-TAMIS required diagnostic laparoscopy with 2-layer closure of the proctotomy made during full-thickness resection, and the patient was discharged postoperative day 2. Two patients from each L- and R-TAMIS required temporary urinary catheterization for urinary retention. Three patients underwent subsequent radical resection due to advanced malignancy. There was a trend toward decreased blood loss in the R-TAMIS group. Mortality was 0% in both groups.
Conclusion: After reviewing our experience, we conclude there is no significant difference between L- and R-TAMIS other than total direct cost. We confirmed that both L- and R-TAMIS are safe and associated with low morbidity. Limitations are the small sample size. In the future, we hope to show promising data on R-TAMIS with increased sample size and experience, which may allow for transanal resection not previously feasible due to location or limitation of the L-TAMIS platform. Studies with long-term follow-up assessing oncological and functional results are mandatory.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86886
Program Number: S032
Presentation Session: Colorectal 1 Session
Presentation Type: Podium