eP236 - Robotic and Laparoscopic Trans-Anal Minimally Invasive Surgery (TAMIS): A Snapshot from Current Literature

Sunday, June 2, 2024

9:12 AM – 9:17 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

Author(s)

AC

Annalisa Comandatore, MD

MD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
SG

Simone Guadagni, MD

MD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
NF

Niccolò Furbetta, MD

MD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
MP

Matteo Palmeri, MD

MD, PhD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
GD

Gregorio Di Franco, MD, PhD

MD, PhD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
FV

Filippo Vagelli, MD

MD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
NR

Niccoló Ramacciotti, MD

MD
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
MS

Marco Scalese, PhD

PhD
Institute of Clinical Physiology, National Council of Research, Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.
GD

Giulio Di Candio, MD

Prof
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
Pisa, Toscana, Italy

Disclosure information not submitted.

ePoster Presenter(s)

Luca Morelli, MD

Prof
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
University of Pisa
Pisa, Toscana, Italy

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Purpose/Background: The field of rectal cancer treatment is dynamic and changing, due to innovations in the surgical technologies. The laparoscopic Transanal Minimally Invasive Surgery (L-TAMIS) is suitable for resection of early neoplastic lesions, nevertheless, is technically challenging for the limited working space. The robotic TAMIS (R-TAMIS) offers improved dexterity, enabling resections with a more stable platform.Methods/Interventions: For this review we analyzed the current literature using as keywords "tamis" with “robotic” and with “laparoscopy” separately. For the comparative studies, we analyzed and expressed as a Standardized Mean Difference with relative confidence intervals (95%CI) the total duration (TD) and the distance from anal verge.Results/Outcomes: Case-series are predominantly found in the literature, while we identified only two comparative studies. In both techniques, the most used device for anal dilatation was the GelPOINT. The device is inserted through the anal canal, over the sphincter muscles, and secured; three 8mm working ports and one 5mm AirSeal®(ConMed-Utica-NY) are placed over the transanal port, an 8mm-30 camera is used. Case-series related to the R-TAMIS technique, primarily describe the use of da VinciXi(Intuitive-Sunnyvale-CA) robotic system. The largest series analyzed 58 R-TAMIS patients: 55 of them had R0 resection margins (RM), while 3 patients developed local recurrence, requiring salvage surgery. A comparative study analyzed 40 patients who underwent L-TAMIS or R-TAMIS. L-TAMIS is “position-dependent” while for R-TAMIS, the position is more independent from lesion location. There was a trend towards reduced blood loss in the R-TAMIS group. The only statistically significant difference between L and R-TAMIS was the direct cost of the procedure: 3562vs4440$ for R-TAMIS. The study also demonstrated a superiority in terms of R0 rates for the robotic technique (94.7%vs90.5%). Interestingly, a second comparative study showed R0 RM frequency of 100% in patients receiving R-TAMIS compared to 83% in L-TAMIS group. In addition, the study revealed a higher reintervention rate after L-TAMIS compared to R-TAMIS. Despite a lower median TD for R-TAMIS, the study showed higher costs (9226vs6362$). The analysis of the two comparative studies indicated no significant differences within the same study and between the two studies for the considered variables.Conclusion/

Discussion: Despite the scarcity of comparative studies and the small sample sizes, the current literature suggests a trend in favor of R-TAMIS. It appears to be faster, with a higher rate of R0-RM, a lower need for additional surgical treatment, improved ergonomics, and no correlation between the patient's position and the lesion localization. The robotic system aids in suturing and allows access to very low lesions, thanks its articulated wrist. Despite these advantages, R-TAMIS is still burdened by higher costs, so large-scale prospective studies are required to validate its superiority.