Single-port robotic transanal minimally invasive surgery (SPR-TAMIS): another giant leap forward?

Abstract

Aim: Minimally invasive transanal platforms are now the standard of care for select low-risk rectal tumours. However, existing platforms come with persistent technical challenges. The da Vinci SP Surgical System™ offers a new alternative designed to work effectively in narrow spaces. This technology has the potential to enhance the feasibility and proximal extent of complex transanal resections. This study aimed to describe the morbidity and technical success in patients undergoing single-port robotic transanal minimally invasive surgery (SPR-TAMIS). Secondary outcomes include rates of local recurrence.

Methods: A retrospective analysis was conducted on all patients who underwent SPR-TAMIS at our institution between February 2019 and December 2023.

Results: The study included 31 patients (19 men, 12 women) with a mean age of 61 ± 13.3 years. The average tumour distance from the anal verge was 10 cm. Thirty patients completed SPR-TAMIS, with one patient requiring conversion to robotic sigmoidectomy due to location in the mid-sigmoid colon. The mean operating time was 106 ± 42 min. Twenty-eight out of 30 patients underwent full-thickness excision and all but two were successfully closed. All specimens were resected intact, and margins were negative in 93.5% of cases. The average tumour size was 13 ± 34 cm², with 13 lesions classified as adenomas and 16 as adenocarcinomas. All patients who did not undergo associated procedures were discharged on the day of surgery. Two patients experienced 30-day morbidity. At a mean follow-up of 18 months (± 13), no local or systemic recurrences were identified.

Conclusion: SPR-TAMIS for excision of low-risk rectal tumours is associated with high rates of technical success and low 30-day morbidity. Further research is needed to compare SPR-TAMIS with other techniques to determine potential advantages over current transanal platforms.