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Robotic Transanal Surgery RTS

Robotic Transanal Surgery RTS. ASCRS - 2012 Sergio W. Larach, MD, FACS, FASCRS Florida Hospital Orlando, FL. TAMIS. TransAnal Minimally Invasive Surgery Developed 2009 1.

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Robotic Transanal Surgery RTS

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  1. Robotic Transanal Surgery RTS ASCRS - 2012 Sergio W. Larach, MD, FACS, FASCRS Florida Hospital Orlando, FL

  2. TAMIS • TransAnal Minimally Invasive Surgery • Developed 2009 1 • Atallah, Albert, Larach. Transanal Minimally Invasive Surgery. A Giant Leap Forward. Surgical Endoscopy. 2009 November

  3. Transanal Minimally Invasive Surgery: A Giant Leap Forward • 6 patients • SILS port • Conventional Laparoscopic Tower • Conventional Laparoscopic Instrumentation • No technical complications

  4. TEM • Invented by Gerhard Buess in 1983 • Benign neoplasms of the mid rectum • Overall slow adoption • Pre-internet (marketing) • Steep learning curve • Few Cases • Complex setup/instrumentation/positioning

  5. TEM Resurgence • Single port “boom” • Neoadjuvant treatments • Aging population • Alternative devices Clinical Publications

  6. TEM • Advantages • Fine dissection • Suturing • Disadvantages • 180-220 degrees

  7. TAMIS • Advantages • Set up time • Positioning • Conventional instrumentation • Flexibility • Disadvantages • Port dislodgement • Maintaining pneumorectum • Instrument conflict • Suturing

  8. TME • Anastomotic leak/sepsis • Permanent colostomy • Urologic complications • Sexual disturbances • Fecal incontinence

  9. New Wave • Less is more!! • Minimally invasive Single Site Transanal NOTES

  10. Drawbacks of TAMIS • Port extrusion • Instrument collision • “sword fighting” • Sub-optimal working angles for dissection and suturing

  11. Advantages of RTS • Articulating instruments • Dexterity • Improved visualization • 3-D image • Magnified view • Maneuverability within the lumen

  12. Disadvantages of RTS • No specifically designed access port • Cap would need to be more durable to take on the stresses of torquing • Bulky instruments • Inability to change trocar positions • No tactile sense of where arms are • Possibility of sphincter injury

  13. RTS Publications • Robotic transanal minimally invasive surgery in a cadaveric model. Sept. 28, 2011 Tech Coloproctol. • Robotic Transanal Surgery (RTS): A description of technique for the first resection of a rectal neoplasm.Atallah S, Albert M, T. deBeche-Adams,Larach S, Parra-Davila E. Under review Tech Coloproctol.

  14. Thank you

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