title: Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study.
abstract: BACKGROUND
  We performed a prospective pilot study of robotic-assisted laparoscopic transanal proctectomy with total mesorectal excision for the surgical treatment of rectal cancer. This study was to assess the feasibility and safety of robotic-assisted laparoscopic transanal total mesorectal excision.
  
  
  METHODS
  All patients underwent robotic-assisted laparoscopic left colon mobilization, robotic-assisted laparoscopic transanal total mesorectal excision, ultralow mechanical colorectal or handsewn coloanal anastomosis, and a diverting loop ileostomy. Four patients with stage III disease received long-course preoperative chemoradiation before surgery.
  
  
  METHODS
  Primary and secondary end points included the assessment of pathological examination and postoperative morbidity.
  
  
  RESULTS
  Between August 2013 and January 2014, 4 men and 1 woman underwent robotic-assisted laparoscopic transanal total mesorectal excision. Patient age and BMI were 57 ± 13.9 years and 25.8 ± 2,7 kg/m. Tumors were located an average of 5 ± 1 cm from the anal verge and were preoperatively staged as T2N0M0 (1 patient) and T2N1M0 (4 patients). Mean operative time was 398 ± 88 minutes with no intraoperative complications. Mean length of hospital stay was 6 ± 1 days. A Clavien II, grade B anastomotic leakage developed in 1 patient postoperatively. In all cases, pathological examination of the total mesorectal excision specimens showed complete mesorectal excision with negative proximal, distal, and circumferential margins. All patients were disease-free at their initial 3-month follow-up.
  
  
  CONCLUSIONS
  Robotic-assisted laparoscopic transanal total mesorectal excision is a feasible and safe option for the surgical management of early-stage rectal cancers. Robotic technology with endowristed instruments and 3-dimensional high-definition imaging are of great help in overcoming the limitations of traditional laparoscopic transanal surgery. Long-term functional and oncological assessments of outcome are needed.
authors.affiliation: Department of Surgery, Hospital Universitario Marqués de Valdecilla, Secretaría de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Marcos
authors.initials: M
authors.lastname: Gómez Ruiz
authors.forename: Ignacio Martín
authors.initials: IM
authors.lastname: Parra
authors.forename: Carlos Manuel
authors.initials: CM
authors.lastname: Palazuelos
authors.forename: Joaquin Alonso
authors.initials: JA
authors.lastname: Martín
authors.forename: Carmen Cagigas
authors.initials: CC
authors.lastname: Fernández
authors.forename: Julio Castillo
authors.initials: JC
authors.lastname: Diego
authors.forename: Manuel Gómez
authors.initials: MG
authors.lastname: Fleitas
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome