Da Vinci Single-Port robot-assisted transanal mesorectal excision: a promising preclinical experience
Werner Kneist, Hubert Stein, Markus Rheinwald, Werner Kneist, Hubert Stein, Markus Rheinwald
Abstract
Introduction: Robotic single-port platforms represent a viable option for advanced surgical procedures. This preclinical study investigated the dual-field, single-port, robot-assisted transanal total mesorectal excision (taTME).
Technique: In a male human cadaver, we employed the novel da Vinci® SP™ Surgical System, sequentially, to realize the transanal and abdominal parts of the taTME procedure. We evaluated the feasibility of the one-team approach.
Results: We showed that single-port access for the taTME was technically feasible with the current da Vinci® SP™ Surgical System in both surgical fields. The total console times were 189 min for the juxta-anal purse-string suture placement, partial intersphincteric resection, and bottom-up mesorectal dissection to where it meets the peritoneal reflection and 43 min for the abdominal procedure. A good quality specimen was achieved. The surgeon comfort was high during simulated surgery. The task load was highly acceptable (NASA-TLX global score: 35), even though it was the surgeon's first use of this platform.
Conclusion: This preclinical study demonstrated that the robotic, single-port taTME was feasible and could be performed with the da Vinci® SP™ Surgical System, beginning at the level of the dentate line. Further simulations are necessary to confirm this promising approach.
Keywords: Da vinci SP; Rectal cancer; Robotic transanal surgery; Robotics; Single-port surgery; Transanal total mesorectal excision (taTME).
Conflict of interest statement
Dr. W. Kneist reports fees, travel and accommodation costs that have been taken over as part of the referent activity from Olympus Germany GmbH, Karl Storz GmbH&Co.KG, Johnson & Johnson Medical GmbH and Merck Serono GmbH. He indicates that financial support and resources for this experimental study were provided by Intuitive Surgical Inc., Sunnyvale, CA, USA. Travel and expense allowance were not accepted. He has no direct conflicts of interest with the content discussed in this manuscript. H. Stein is the senior director of global clinical development and an employee of Intuitive Surgical, Sunnyvale, CA, USA. Dr. M. Rheinwald is the Senior Manager of Clinical Applications Europe an employee of Intuitive Surgical, Sunnyvale, CA, USA.
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Source: PubMed