Afifa Naseer
Introduction
Transanal minimally invasive surgery (TAMIS) is a well-established technique for local excision of rectal lesions. We evaluated the feasibility and early outcomes of robotic TAMIS (rTAMIS) following its introduction at our institution.
Methods
A retrospective analysis was performed of consecutive rTAMIS procedures undertaken over six-month period. The primary outcome was technical feasibility. Secondary outcomes included quality of excision, peri-operative outcomes and safety. Patient demographics, lesion characteristics, operative metrics, pathological outcomes and short-term oncological surrogates were analyzed.
Results
Twenty-one patients underwent rTAMIS (median age 76 years; 40% ASA III–IV). Median lesion size was 3.0 cm (range 2–9 cm), with a median distance from the anal verge of 6.1 cm, extending up to 11 cm. Median operating time was 32 minutes with minimal blood loss. All lesions were successfully excised robotically, with no conversions. En-bloc resection was achieved in 95% of cases, and complete (R0) resection was confirmed in 100% following surveillance assessment. No peri-operative complications or readmissions occurred and 90% patients were discharged the same day. Eight malignant lesions were treated, including six pT1 cancers managed with surveillance and two pT2 cancers in nonoperative candidates. One local recurrence (4.7%) was detected on surveillance and managed appropriately. Outcomes were comparable to published TAMIS systematic review data.
Conclusion
Robotic TAMIS is technically feasible and safe, even for larger and more proximal rectal lesions in a high-risk cohort. Early outcomes demonstrate acceptable procedural completion, low morbidity and rapid recovery, supporting adaption as viable organ-preserving approach with enhanced dexterity, stability and ergonomics.
Authors
Afifa Naseer, Michail Klimovskij, Yesar El-Dhuwaib
Conquest Hospital, Hastings, United Kingdom