Transanal Endoscopic Da Vinci Surgery (teds): Results of Cadaveric Experiments

Background:
single port platforms and instrument are increasingly used for transanal surgery. In an effort to tackle some of the limitations and increase intraluminal flexibility, robotic integration could be a logical next step.

Objective:
To report on our initial experience with transanal endoscopic da Vinci surgery (TEdS) using a glove port on human cadavers.

Methods:
After initial dry lab experiments, the feasibility of TEdS and ideal set-up was further evaluated in human cadavers. For transanal access we used a glove port that is constructed on table by using a circular andal dilator (CAD), a standard wound retractor and a surgical glove. A da Vinci SI HD system was used in combination with the glove port for transanal endoscopic resections.

Results:
We were able to perform all necessary tasks necessary to complete a full thickness excision and closure of the rectal wall, with cadavers in prone and supine position. The stable magnified view, together with the endowrist technology of the robotic instruments made every task straightforward. Intraluminal maneuverability could further be improved by intersecting the robotic instruments. The glove port proved to be very reliable and the inherent flexibility of the glove made docking of the robotic arms, in a narrow confined space easy.

Conclusions:
TEdS using a cheap and universally available glove port is feasible, and we were able to determine a preferred set-up. Further clinical trials will be necessary to assess safety and efficacy of this technique.

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