Erschienen in:
24.10.2017 | Technical Advances
Assessment of a flexible robotic system for endoluminal applications and transanal total mesorectal excision (taTME): Could this be the solution we have been searching for?
verfasst von:
S. Atallah
Erschienen in:
Techniques in Coloproctology
|
Ausgabe 10/2017
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Excerpt
Experimentation with robotic transanal surgery (RTS) began in 2011 [
1] as a natural evolution of transanal minimally invasive surgery (TAMIS) [
2]. Using first-, second-, and eventually third-generation multi-arm Da Vinci
S,
Si, and
Xi master–slave robotic systems (Intuitive Surgical Systems, Sunnyvale, CA, USA), RTS has evolved from endoluminal applications [
3] (most notably for local excision of rectal neoplasia) to subsequent use as a platform for transanal total mesorectal excision (taTME), with the first such case reported in 2013 [
4]. To date, several feasibility studies and pilot investigations with RTS have been described for local excision and taTME [
5‐
19], leading some surgeons to believe that transanal approaches could represent a “sweet spot” for robotics in colorectal surgery [
20] and a solution to its Achilles’ heel [
21,
22]. While RTS can achieve extreme operative precision, the principle shortcoming of the approach has been that straight instruments and the multiple, bulky Da Vinci arms limit the ability to dock the robotic cart transanally and access the anorectum and pelvis in this manner; this in turn translates into limited proximal reach. …
