Transanal Robot-Assisted TME with Robot-Assisted Abdominal Laparoscopy

Chapter

Abstract

Open anterior resection with total mesorectal excision (TME) is the standard method of rectal cancer resection. However, this procedure remains technically difficult and has a high morbidity associated. Minimally invasive approaches may help to reduce these morbidities even though they still have some technical limitations. A robotic transanal approach could overcome some of these limitations and reduce the morbidities improving oncological and functional outcomes.

The feasibility of robotic transanal TME and set-up has been evaluated in different pilot studies.

Using the robotic technology and a specifically designed port for robotic transanal access, TME was shown to be feasible, and one specific preferred set-up was determined. Further clinical trials are still necessary to assess the safety and efficacy of this technique. In this chapter we describe a standardized technique after our initial clinical experience.

The standardization of this technique may help in this assessment and in the evolution to a natural orifice translumenal endoscopic surgery proctectomy with TME in the future.

Keywords

Rectal cancer Robotic transanal surgery 

References

  1. 1.
    Gomez Fleitas M. From Miles’ procedure to robotic transanal proctectomy. Cir Esp. 2014;92(8):507–9. doi: 10.1016/j.ciresp.2014.01.001.CrossRefPubMedGoogle Scholar
  2. 2.
    Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22(3):277–81.PubMedGoogle Scholar
  3. 3.
    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med. 1988;81(9):503–8.PubMedPubMedCentralGoogle Scholar
  5. 5.
    WE M. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet. 1908;2:1812–3.Google Scholar
  6. 6.
    Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg. 2004;240(2):260–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bujko K, Rutkowski A, Chang GJ, Michalski W, Chmielik E, Kusnierz J. Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence? A systematic review. Ann Surg Oncol. 2012;19(3):801–8. doi: 10.1245/s10434-011-2035-2.CrossRefPubMedGoogle Scholar
  8. 8.
    Schiessel R, Wunderlich M, Waneck R. Results of colo-anal anastomosis in deep-seated tumors of the rectum. Chirurg. 1986;57(12):792–6.PubMedGoogle Scholar
  9. 9.
    Marks G, Mohiuddin M, Borenstein B. Preoperative radiation therapy and sphincter preservation by the combined abdominotranssacral technique for selected rectal cancers. Dis Colon Rectum. 1985;28(8):565–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Siegel R, Cuesta MA, Targarona E, Bader FG, Morino M, Corcelles R, et al. Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2011;25(8):2423–40. doi: 10.1007/s00464-011-1805-z.CrossRefPubMedGoogle Scholar
  11. 11.
    DiMarino Benjamin AJ. Gastrointestinal disease an endoscopic approach. 2nd ed. Thorofare, NJ: Ed Snack Incorporated; 2002.Google Scholar
  12. 12.
    Buess G, Theiss R, Gunther M, Hutterer F, Pichlmaier H. Transanal endoscopic microsurgery. Leber Magen Darm. 1985;15(6):271–9.PubMedGoogle Scholar
  13. 13.
    Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1(3):144–50.PubMedGoogle Scholar
  14. 14.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–662.; discussion 62–4. doi: 10.1097/SLA.0b013e318155a762.CrossRefPubMedGoogle Scholar
  15. 15.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–84. doi: 10.1016/S1470-2045(05)70221-7.CrossRefPubMedGoogle Scholar
  16. 16.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8. doi: 10.1200/JCO.2006.09.7758.CrossRefPubMedGoogle Scholar
  17. 17.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Delaney CP, Lynch AC, Senagore AJ, Fazio VW. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum. 2003;46(12):1633–9. doi: 10.1097/01.DCR.0000098941.42470.D9.CrossRefPubMedGoogle Scholar
  19. 19.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006;20(10):1521–5. doi: 10.1007/s00464-005-0855-5.CrossRefPubMedGoogle Scholar
  20. 20.
    Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, et al. Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg. 2013;257(4):672–8. doi: 10.1097/SLA.0b013e318269d03b.CrossRefPubMedGoogle Scholar
  21. 21.
    Jensen CC, Prasad LM, Abcarian H. Cost-effectiveness of laparoscopic vs. open resection for colon and rectal cancer. Dis Colon Rectum. 2012;55(10):1017–23. doi: 10.1097/DCR.0b013e3182656898.CrossRefPubMedGoogle Scholar
  22. 22.
    Whiteford MH, Denk PM, Swanstrom LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc. 2007;21(10):1870–4. doi: 10.1007/s00464-007-9552-x.CrossRefPubMedGoogle Scholar
  23. 23.
    Sylla P, Sohn DK, Cizginer S, Konuk Y, Turner BG, Gee DW, et al. Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc. 2010;24(8):2022–30. doi: 10.1007/s00464-010-0898-0.CrossRefPubMedGoogle Scholar
  24. 24.
    Trunzo JA, Delaney CP. Natural orifice proctectomy using a transanal endoscopic microsurgical technique in a porcine model. Surg Innov. 2010;17(1):48–52. doi: 10.1177/1553350609359516.CrossRefPubMedGoogle Scholar
  25. 25.
    Leroy J, Cahill RA, Perretta S, Forgione A, Dallemagne B, Marescaux J. Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc. 2009;23(1):24–30. doi: 10.1007/s00464-008-0102-y.CrossRefPubMedGoogle Scholar
  26. 26.
    Leroy J, Barry BD, Melani A, Mutter D, Marescaux J. No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. JAMA Surg. 2013;148(3):226–30. discussion 31CrossRefPubMedGoogle Scholar
  27. 27.
    Telem DA, Han KS, Kim MC, Ajari I, Sohn DK, Woods K, et al. Transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) with total mesorectal excision in a large human cadaver series. Surg Endosc. 2013;27(1):74–80. doi: 10.1007/s00464-012-2409-y.CrossRefPubMedGoogle Scholar
  28. 28.
    Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24(5):1205–10. doi: 10.1007/s00464-010-0965-6.CrossRefPubMedGoogle Scholar
  29. 29.
    Tuech JJ, Bridoux V, Kianifard B, Schwarz L, Tsilividis B, Huet E, et al. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance. Eur J Surg Oncol. 2011;37(4):334–5. doi: 10.1016/j.ejso.2010.12.016.CrossRefPubMedGoogle Scholar
  30. 30.
    Zorron R, Phillips HN, Coelho D, Flach L, Lemos FB, Vassallo RC. Perirectal NOTES access: “down-to-up” total mesorectal excision for rectal cancer. Surg Innov. 2012;19(1):11–9. doi: 10.1177/1553350611409956.
  31. 31.
    Dumont F, Goere D, Honore C, Elias D. Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum. 2012;55(9):996–1001. doi: 10.1097/DCR.0b013e318260d3a0.CrossRefPubMedGoogle Scholar
  32. 32.
    de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)—short-term outcomes in the first 20 cases. Surg Endosc. 2013;27(9):3165–72. doi: 10.1007/s00464-013-2872-0.CrossRefPubMedGoogle Scholar
  33. 33.
    Tuech JJ, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg. 2015;261(2):228–33. doi: 10.1097/SLA.0000000000000994.
  34. 34.
    Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Diaz del Gobbo G, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. 2015;261(2):221–7. doi: 10.1097/SLA.0000000000000865.CrossRefPubMedGoogle Scholar
  35. 35.
    Atallah S, Nassif G, Polavarapu H, deBeche-Adams T, Ouyang J, Albert M, et al. Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration. Tech Coloproctol. 2013;17(4):441–7. doi: 10.1007/s10151-013-1039-2.CrossRefPubMedGoogle Scholar
  36. 36.
    Gomez Ruiz M, Martin Parra I, Calleja Iglesias A, Stein H, Sprinkle S, Manuel Palazuelos C, et al. Preclinical cadaveric study of transanal robotic proctectomy with total mesorectal excision combined with laparoscopic assistance. Int J Med Robot. 2015;11(2):188–93. doi: 10.1002/rcs.1581.CrossRefPubMedGoogle Scholar
  37. 37.
    Gomez Ruiz M, Palazuelos CM, Martin Parra JI, Alonso Martin J, Cagigas Fernandez C, del Castillo Diego J, et al. New technique of transanal proctectomy with completely robotic total mesorrectal excision for rectal cancer. Cir Esp. 2014;92(5):356–61. doi: 10.1016/j.ciresp.2013.12.007.CrossRefPubMedGoogle Scholar
  38. 38.
    Verheijen PM, Consten EC, Broeders IA. Robotic transanal total mesorectal excision for rectal cancer: experience with a first case. Int J Med Robot. 2014;10(4):423–6. doi: 10.1002/rcs.1594.CrossRefPubMedGoogle Scholar
  39. 39.
    Huscher CG, Bretagnol F, Ponzano C. Robotic-assisted transanal total mesorectal excision: the key against the Achilles’ heel of rectal cancer? Ann Surg. 2015;261(5):e120–1. doi: 10.1097/SLA.0000000000001089.CrossRefPubMedGoogle Scholar
  40. 40.
    Atallah S, Martin-Perez B, Pinan J, Quinteros F, Schoonyoung H, Albert M, et al. Robotic transanal total mesorectal excision: a pilot study. Tech Coloproctol. 2014;18(11):1047–53. doi: 10.1007/s10151-014-1181-5.CrossRefPubMedGoogle Scholar
  41. 41.
    Gomez Ruiz M, Parra IM, Palazuelos CM, Martin JA, Fernandez CC, Diego JC, et al. Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum. 2015;58(1):145–53. doi: 10.1097/DCR.0000000000000265.CrossRefPubMedGoogle Scholar
  42. 42.
    Wexner SD, Berho M. Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg. 2015;261(2):234–6. doi: 10.1097/SLA.0000000000000886.CrossRefPubMedGoogle Scholar
  43. 43.
    Sylla P. Robotically assisted transanal total mesorectal excision: an exciting new trend in rectal cancer surgery. Ann Surg. 2015;261(5):e122. doi: 10.1097/SLA.0000000000001090.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2018

Authors and Affiliations

  1. 1.Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Aparato DigestivoHospital Universitario Marqués de ValdecillaSantanderSpain
  2. 2.Secretaría de Cirugía General y Aparato DigestivoPabellón 19 Bajo, Hospital Universitario Marqués de ValdecillaSantanderSpain

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