AB020. SOH22ABS065. Robotic transanal minimally invasive surgery (TAMIS): the initial Irish experience

Background: Traditional laparoscopic transanal minimally invasive surgery (L-TAMIS) is technically challenging due to the limitations of rigid laparoscopic instruments in the narrow rectal lumen. Robotic TAMIS (R-TAMIS) represents an exciting new development that may improve the ergonomics of L-TAMIS. In this series, we describe our initial experience with R-TAMIS.

Methods: A retrospective review of patients that underwent R-TAMIS during a one-year period was performed. Demographic, perioperative, postoperative and histopathological data was collected.

Results: Six patients (mean age 70 years, 66.7% male) underwent R-TAMIS performed by two surgeons for endoscopically unresectable rectal lesions during the study period. Tumour distance from the anal verge ranged from to 12 cm. The maximum diameter of the lesions ranged from 2 to 6 cm. The median duration of surgery was 94 minutes (median robotic docking time 30 minutes). Blood loss was minimal in all cases, with no conversion to intra-abdominal surgery. The median length of stay was 1 day. No postoperative complications were recorded. All lesions were removed fully without the requirement for further surgery. The final histopathological results were tubulovillous adenoma with high grade dysplasia (n=5) and pT1 moderately differentiated adenocarcinoma (n=1).

Conclusions: R-TAMIS is a safe alternative to L-TAMIS for resection of endoscopically unresectable benign rectal polyps and early rectal cancers. The greater versatility of robotic platforms may allow lesions that would be considered unsuitable for L-TAMIS to be managed by local excision. R-TAMIS is an important evolution in transanal surgery which allows patients to avoid the risks associated with more radical resection in early-stage rectal cancers and benign lesions.

Keywords: Rectal cancer; robotic surgery; transanal minimally invasive surgery (TAMIS); transanal surgery