Adam Studniarek, MD, Matthew Ng, MD, Gerald Gantt, MD, Mohammad Shokouh-Amiri, MD, Anders Mellgren, MD, PhD, Johan Nordenstam, MD, PhD. University of Illinois at Chicago
Background: Transanal minimally invasive surgery (TAMIS) was originally introduced as a hybrid technique between Transanal Endoscopic Surgery (TEM) and single site laparoscopy for resection of benign and early-staged malignant rectal lesions. Originally described in 2010 by Attalah et al, TAMIS was designed to allow access to mid-rectal and more proximal lesions. The continued evolution of minimally invasive techniques and the advantages of robotic surgery introduced a concept of robotic surgery in rectal lesions. Experimental work in cadaveric models has confirmed that Robotic TAMIS (R-TAMIS) is a potential option. R-TAMIS is still considered to be a novel technique among colorectal surgeons.
Case report: A 57-year old male presented with a 3 year history of hematochezia. From an outside facility, the patient was diagnosed with a large rectal mass located 6 cm from the anal verge. The biopsy demonstrated tubullovillous adenoma, negative for high grade dysplasia. Endoscopic rectal ultrasound (ERUS) demonstrated a mass located in the right posterolateral rectal wall with submucosal invasion but no extension into the muscularis propria. No evidence of lymphadenopathy was noted. The decision was made to proceed with R-TAMIS for full thickness excision of the large rectal mass. In the operating room, the patient was placed in the right lateral decubitus position and GelPoint platform was inserted into the anal canal. Full thickness excision of the pedunculated rectal mass was performed. The defect was closed using 3-0 running v-loc sutures. Following the surgery, patient was admitted overnight for observation and discharged home the next day. The surgical biopsy demonstrated T1, sm1 well differentiated adenocarcinoma.
Discussion: The use of a robotic system in transanal surgery is the most recent evolution of natural orifice surgery for the treatment of low risk rectal lesions. We present a case of a successful full thickness transanal excision of a large rectal polyp using R-TAMIS technique. The advantages of robotic system in a small confined space of the pelvis allows for an adequate resection with improved visualization in comparison to conventional methods. Robotic transanal minimally invasive surgery is a viable option for resection of early stage rectal lesions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95338
Program Number: V274
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop