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Robotic transanal minimally invasive surgery (TAMIS) for local excision of rectal lesions with the da Vinci Xi (dVXi): technical considerations and video vignette

Abstract

Robotic transanal minimally invasive surgery (TAMIS) (RT) represents a compelling new alternative capable of overcoming the limitations of conventional TAMIS for the local excision of rectal lesions. We describe our RT technique using the dVXi™ (Intuitive Surgical, Sunnyvale, CA, USA) which we have used to efficiently and completely excise eight cases of rectal lesions which were not endoscopically resectable. We also include a video vignette of the procedure. With the patient in the prone jackknife position, we insert a GelPOINT™ Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, CA, USA) in combination with the dVXi and AirSeal™ insufflation system (Conmed, Niagara. Falls, ON, Canada). Our technique aims to be ergonomically efficient to minimise docking difficulties and to reduce instrument clash in the limited space, whilst maximising the capabilities of the dVXi for RT. At 3-month endoscopic follow-up, no evidence of recurrence was detected in any of the eight patients. RT is safe, feasible and has advantages over conventional laparoscopic TAMIS (LT). Our described technique addresses some of the long-standing challenges of LT and the novel RT. The immediate challenge to its widespread use remains the cost, expertise and availability.

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Author information

Correspondence to C. D. Warren.

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Conflict of interest

Associate Professor Andrew Stevenson is a regular course convenor and faculty member for the TAMIS course organized by Applied Medical. The other authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any research on human participants or animals performed by any of the authors. It describes modification of a technique of an established surgical procedure.

Informed consent

Informed consent was obtained from the patient involved as well as clearance from the primary treating surgeon.

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Supplementary material 1 (MP4 302729 KB)

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Warren, C.D., Hamilton, A.E.R. & Stevenson, A.R.L. Robotic transanal minimally invasive surgery (TAMIS) for local excision of rectal lesions with the da Vinci Xi (dVXi): technical considerations and video vignette. Tech Coloproctol 22, 529–533 (2018) doi:10.1007/s10151-018-1816-z

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Keywords

  • Robotic transanal surgery (RTAS)
  • Transanal endoscopic surgery (TEM)
  • Transanal minimally invasive surgery (TAMIS)
  • Robotic TAMIS