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Robotic LAR with Transanal Extraction

Robotic LAR with Transanal Extraction. Alessio Pigazzi City of Hope Duarte, CA. A history of Lap TA extraction -Franklin procedure. First shown by Franklin in early 1990s for Recto/sigmoid resection. Advantages: Cosmetically pleasing Lower hernia rate Lower wound infection

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Robotic LAR with Transanal Extraction

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  1. Robotic LAR with Transanal Extraction Alessio Pigazzi City of Hope Duarte, CA

  2. A history of Lap TA extraction -Franklin procedure • First shown by Franklin in early 1990s for Recto/sigmoid resection. • Advantages: • Cosmetically pleasing • Lower hernia rate • Lower wound infection • Better anastomosis? • Disadvantages • Technically demanding • Oncologically safe?

  3. Franklin’s transanal extraction

  4. Anastomosis

  5. Indications • Can be done for • Benign disease • Selected cancers • Avoid large tumors What about rectal cancer?

  6. Types of Rectal Transanal ResectionLife within 8 cm of the outside world Inter SphinctericColoanal AA Low Anterior Resection Colorectal AA

  7. 40 Intersphincteric resection vs 37 CAA • 1990-2000 • Same frequency, urgency, fragmentation • Wexner incontinence score higher in ISR • 10.8 ISR vs 6.9 CAA • Higher use of antidiarrheals in ISR

  8. Double stapled AA

  9. SurgEndosc, 2010 • 13 patients • 11 transanal extraction • 2 Transvaginal extractions • Complications :2 patients (15%) • Anastomotic leak: 1 • Bleeding anastomosis:1 • No report of incontinence

  10. Robotic low anterior resection with TA extraction • Potential to have • Superior cosmetic results • Lower wound infection rates • Lowe hernia rate • Better continence data than coloanalanastomosis

  11. Robotic transanal extraction with double purse string aa.

  12. City of Hope experience Double Purse String AA. 4 patients (3F;1M) Age: 58 Mean distance tumor anal verge: 8 cm Ileostomy:2 Complications: None Mean Wexner score: 3.5 (2-6)

  13. Conclusions • Resection with transanal extraction ideal minimally invasive procedure • Combines Open, LAP, Endoscopic skills • Robotic technology makes the procedure more applicable to low anterior resection • Preliminary data encouraging-more studies are needed

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