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Assessment of the Versius surgical robotic system for dual-field synchronous transanal total mesorectal excision (taTME) in a preclinical model: will tomorrow’s surgical robots promise newfound options?

Abstract

Background

The aim of this study was to evaluate the feasibility of the Versius surgical robotic system for transanal total mesorectal excision (taTME) in a preclinical setting.

Methods

Dry laboratory and cadaveric sessions were first conducted for three experienced colorectal surgeons in order to gain familiarity with the modular surgical system and the robotic workstation. After introduction, the system was configured to allow for synchronous, totally robotic taTME in a cadaver.

Results

Using the modular robotic system, one surgeon performed the abdominal portion of the operation, including colonic mobilization and vascular pedicle ligation while simultaneously a second surgeon performed the transanal portion of the operation to the point of rendezvous at the peritoneal reflection, where the operation was completed cooperatively. The operation was successfully completed in 195 min demonstrating preclinical feasibility of this unique approach with an emerging robotic system.

Conclusions

This is the first preclinical assessment of the Versius surgical robotic system for taTME. The ability to work simultaneously carries the theoretical advantage of reducing surgical time and thereby reducing overall operative costs. It may also allow surgeons to maintain focus on critical parts of the operation by halving the fatigue associated with long, complex cases such as taTME.

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References

  1. 1.

    Vignali A, Elmore U, Milone M, Rosati (2019) Transanal total mesorectal excision (TaTME): current status and future perspectives. Updates Surg 8:15. https://doi.org/10.1007/s13304-019-00630-7

  2. 2.

    Westwood DA, Cuda TJ, Hamilton AER, Clark D, Stevenson ARL (2018) Transanal total mesorectal excision for rectal cancer: state of the art. Tech Coloproctol 22:649–655

  3. 3.

    Simillis C, Lal N, Thoukididou SN, Kontovounisios C, Smith JJ, Hompes R, Adamina M, Tekkis PP (2019) Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg. https://doi.org/10.1097/sla.0000000000003227 [Epub ahead of print]

  4. 4.

    Marks J, Ng S, Mak T (2017) Robotic transanal surgery (RTAS) with utilization of a next-generation single-port system: a cadaveric feasibility study. Tech Coloproctol 21:541–545

  5. 5.

    Atallah S, Hodges A, Larach SW (2018) Direct target NOTES: prospective applications for next generation robotic platforms. Tech Coloproctol 22:363–371

  6. 6.

    Atallah S (2017) Assessment of a flexible robotic system for endoluminal applications and transanal total mesorectal excision (taTME): could this be the solution we have been searching for? Tech Coloproctol 21:809–814

  7. 7.

    Medina MG, Tsoraides SS, Dwyer AM 3rd (2018) Review and update: robotic transanal surgery (RTAS). Updates Surg 70:369–374

  8. 8.

    Vitiello V, Lee SL, Cundy TP, Yang GZ (2013) Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 6:111–126

  9. 9.

    Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32:1636–1655

  10. 10.

    Arroyave MC, DeLacy FB, Lacy AM (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: step by step description of the surgical technique for a two-teams approach. Eur J Surg Oncol 43:502–505

  11. 11.

    Macario A (2010) What does one minute of operating room time cost? J Clin Anesth 22:233–236

  12. 12.

    Shippert RD (2005) A study of time-dependent operating room fees and how to save $100 000 by using time-saving products. Am J Cosm Surg 22:25–34

  13. 13.

    Childers CP, Maggard-Gibbons M (2018) Understanding the cost of care in the operating room. JAMA Surg 153(4):e176233. https://doi.org/10.1001/jamasurg.2017.6233

  14. 14.

    Atallah S, Martin-Perez B, Pinan J, Quinteros F, Schoonyoung H, Albert M, Larach S (2014) Robotic transanal total mesorectal excision: a pilot study. Tech Coloproctol 18:1047–1053

  15. 15.

    Andolfi C, Umanskiy K (2018) Appraisal and current considerations of robotics in colon and rectal surgery. J Laparoendosc Adv Surg Tech 16:15. https://doi.org/10.1089/lap.2018.0571 [Epub ahead of print]

  16. 16.

    Atallah S, Nassif G, Polavarapu H, deBeche-Adams T, Ouyang J, Albert M, Larach S (2013) Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration. Tech Coloproctol 17:441–447

  17. 17.

    Huscher CG, Bretagnol F, Ponzano C (2015) Robotic-assisted transanal total mesorectal excision: the key against the Achilles’ heel of rectal cancer? Ann Surg 261(5):e120–e121

  18. 18.

    Gómez Ruiz M, Parra IM, Palazuelos CM, Martín JA, Fernández CC, Diego JC, Fleitas MG (2015) Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum 58:145–153

  19. 19.

    Atallah S, Zenoni S, Kelly J, Tilahun Y, Monson JR (2016) A blueprint for robotic navigation: pre-clinical simulation for transanal total mesorectal excision (taTME). Tech Coloproctol 20:653–654

  20. 20.

    Ye T, Sun Y, Zhang Y, Zhang Y, Chen H (2013) Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. The Annals of thoracic surgery. Dec 1;96(6):1933-41

  21. 21.

    Kearns JE, Nesselrod JP (1955) Two-team combined abdominoperineal operation. Q Bull Northwest Univ Med Sch 29:154

  22. 22.

    Childers CP, Maggard-Gibbons M (2018) Estimation of the Acquisition and Operating Costs for Robotic Surgery. JAMA 28;320(8):835-836. https://doi.org/10.1001/jama.2018.9219

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Author information

Correspondence to S. Atallah.

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Disclosures

Dr. S. Atallah reports consultancy (such as consulting fees, honoraria) from Medtronic, Applied Medical, ConMed, Inc, and Medrobotics. Dr. A.G.F. Melani receives remuneration (payment for services not otherwise identified as salary such as consulting fees, honoraria) from Medtronic, Ethicon, Intuitive Surgical, and Verb Surgical though he has no direct conflicts of interest with content discussed in this manuscript. Dr. E. Parra-Davila receives remuneration (payment for services not otherwise identified as salary such as consulting fees, honoraria) from Medtronic, Ethicon, Intuitive Surgical, and Verb Surgical though he has no direct conflicts of interest with content discussed in this manuscript.

Ethical approval

This research was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained in accordance with the standards set forth by hospital regulations.

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Atallah, S., Parra-Davila, E. & Melani, A.G.F. Assessment of the Versius surgical robotic system for dual-field synchronous transanal total mesorectal excision (taTME) in a preclinical model: will tomorrow’s surgical robots promise newfound options?. Tech Coloproctol 23, 471–477 (2019). https://doi.org/10.1007/s10151-019-01992-1

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Keywords

  • Cooperative robotic surgery
  • Two-field surgery
  • taTME
  • Cecil approach
  • Synchronous surgery
  • Versius
  • Modular surgical robotics