Robotic TAMIS - technical, oncological and patient outcomes from a single institution.

INTRODUCTION: Robotic transanal minimally invasive surgery (R-TAMIS) is gaining traction around the globe as an alternative to laparoscopic conventional TAMIS (L-TAMIS) for local excision of benign and early malignant rectal lesions. AIMS: To analyse patient and oncological outcomes of R-TAMIS in a single centre of consecutive cases. METHODS: A prospective analysis of consecutive R-TAMIS procedures over a 12-month period was performed. Data was collated from hospital databases and theatre registers. RESULTS: Eleven patients (6M, 5F), mean age 69.81 years (51 -92years) underwent R-TAMIS over 12 months utilising a Da Vinci Xi platform. The mean lesion size was 36mm (20mm - 60mm) with a mean distance from anal verge of 7.5cm (3- 14cm). Five lesions were posterior in anatomical location, 4 anterior, one right lateral and one left lateral. All procedures were performed in the lithotomy position using a GelPOINT path platform. Mean operative time was 64 minutes (40 - 100mins). Complete resection was achieved in 10/11 patients with two patients being upgraded to a diagnosis of adenocarcinoma. Nine patients were diagnosed with dysplastic lesions. Four patients had a false positive diagnosis of an invasive tumour on MRI. Six patients required suturing for full thickness resections. One patient had a bleed post-op requiring repeat endoscopy and clipping. One patient (full thickness resection of T3 tumour) proceeded to a formal resection without difficulty with no residual disease (T0N0, 0/22). One patient with a fully resected T2 tumour is undergoing surveillance protocol. The mean length of stay (LOS) was 1 day with two patients having a LOS of 2 days and one patient of 4 days. CONCLUSION: R- TAMIS could potentially represent a safe novel approach for local resection of rectal lesions.