robotic lar with transanal extraction alessio pigazzi city of hope duarte, ca
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Robotic LAR with Transanal Extraction
Alessio PigazziCity of HopeDuarte, CA
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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?
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Franklin’s transanal extraction
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Anastomosis
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Indications
Can be done for• Benign disease• Selected cancers
Avoid large tumors
What about rectal cancer?
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Types of Rectal Transanal ResectionLife within 8 cm of the outside world
Low AnteriorResectionColorectal AA
InterSphincteric Coloanal AA
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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
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Double stapled AA
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13 patients• 11 transanal extraction • 2 Transvaginal extractions• Complications :2 patients (15%)• Anastomotic leak: 1• Bleeding anastomosis:1• No report of incontinence
Surg Endosc, 2010
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Robotic low anterior resection with TA extraction
Potential to have• Superior cosmetic results• Lower wound infection rates• Lowe hernia rate• Better continence data than coloanal
anastomosis
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Robotic transanal extraction with double purse string aa.
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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)
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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