The outcomes of two robotic platforms performing transanal minimally invasive surgery for rectal neoplasia: a case series of 21 patients

Colorectal cancer remains the third most common cancer effecting adults. Surgical guidelines recommend transanal excision of early rectal neoplasia up to 8 cm from the anal verge. A retrospective review of two novel approaches for transanal robotic local excision with R0 resections of rectal cancers which was, on average, higher than 8 cm. Twenty-one cases of robotic assisted transanal surgery for early stage disease (T0-T1, N0) were reviewed. The first 10 cases performed with the da Vinci (R) Si robotic platform between 2013 and 2016, and the first 11 cases performed using the Flex (R) Medrobotics platform between August 2017 and August 2018. The average distance from the anal verge was 11.1 cm and 9.5 cm for the da Vinci (R) Si and Flex (R) Colorectal Drive, respectively. The average operative time was 167.6 min for the da Vinci (R) Si and 110.1 min for the Flex (R) Colorectal Drive; the average EBL was 37.5 cc and 9.1 cc for the da Vinc (R) Si and Flex (R) Colorectal Drive. In the da Vinci (R) series, four cases required intraoperative conversion. In the Flex (R) series, one case was aborted due to unfavorable robotic positioning. All margins were histologically negative when surgically complete with no recurrences to date. Transanal robotic surgery may provide a method to address rectal lesions farther from the anal verge than previously described. The Flex(R)Colorectal Drive platform may provide superior ability to navigate the nonlinear anatomy of the rectum and distal sigmoid colon.