Initial Experience With a Novel Flexible Endoscopic Robotic Device That Allows Full Resection of Colorectal Lesions and Suturing

Abstract

Conventional endoscopic instruments have intrinsic technical limitations, restraining surgeons’ ability to perform specific colorectal resections with lower complication rates and optimal oncologic results. Robotic transanal surgery has been a recent contribution, considered promising in terms of safety profile, technical learning curve, and oncologic outcomes, an alternative that can ergonomically improve surgeons’ ability to perform more complex procedures. The aim of this study is to report preliminary results regarding the feasibility, safety, and efficacy of ColubrisMX ELS, an endoluminal robotic system for complex polyps and incipient colorectal tumor resection. This was a prospective, single-arm, multicenter study to evaluate the feasibility, safety, and efficacy of an endoluminal robotic system (ColubrisMX ELS) in 8 patients who underwent transanal procedures. All patients were followed up at 7, 30, and 60 days; complication, readmission, and conversion rates, as well as operative time and blood loss, were used to measure safety. Success rates were used to measure efficacy and encompassed the number of procedures performed with a complete tumor resection. Eight patients underwent robotic transanal surgery for local excision of benign or incipient neoplasia over a period of 5.5 months, with a success rate of 100%. Of these, 2 patients (25%) underwent conversions, 1 to manage hemorrhage using endoscopic clips and 1 to complete a polypectomy with the cold snare technique. The mean operative time, from insertion to removal of the transanal flexible tube, was 184 minutes (min 79-max 537), whereas the mean length of hospital stay was 30 hours (min 24-max 144). This approach using a new platform represents a “work in progress” that has the potential to improve not only surgical ergonomics but also surgical outcomes.