EP584 - Rectal Robot Rumble: Comparing Outcomes For Laparoscopy, Xi and SP Robotic Surgical Platforms For Transanal Minimally Invasive Surgery.

Sunday, May 11, 2025

4:11 PM – 4:16 PM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

Suzanne M. Arnott, MD (she/her/hers)

Colorectal Surgery Fellow
Swedish Medical Center
Seattle, WA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Grace C. Chang, DO

MIS Colorectal Surgery Fellow
MultiCare Health Network
Tacoma, WA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
BC

Brian T. Carr, II, MD

Fellow - Colon and Rectal Surgery
Swedish
Kirkland, Washington, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JB

Joanne Bae, n/a

Medical Student
Washington State University Elson S. Floyd College of Medicine
Seattle, Washington, United States

Disclosure information not submitted.
JG

John A. Griffin, MD (he/him/his)

Chair of Swedish Integrated Network Cancer Program
Swedish Cancer Institute
Seattle, WA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MH

Melinda E. Hawkins, MD (she/her/hers)

Colorectal surgeon
Swedish Medical Center
Seattle, Washington, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AB

Amir Bastawrous

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Laila Rashidi, MD, FACS, FASCRS (she/her/hers)

Colorectal Surgeon
MutiCare Health Network
Washington State University
Seattle, Washington, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

Senior Author(s)

Lindsay SCEATS, MS MS

Colorectal Surgeon
Swedish Medical Center
Bellevue, Washington, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Suzanne M. Arnott, MD: This individual has no financial relationships with ineligible companies.

Grace C. Chang, DO: This individual has no financial relationships with ineligible companies.

Brian T. Carr, MD, II: This individual has no financial relationships with ineligible companies.

John A. Griffin, MD: This individual has no financial relationships with ineligible companies.

Melinda E. Hawkins, MD: This individual has no financial relationships with ineligible companies.

Amir Bastawrous: This individual has no financial relationships with ineligible companies.

Laila Rashidi, MD, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.

Lindsay SCEATS, MS MS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: TAMIS has increased the technical ability to resect mid to high rectal lesions using a variety of minimally invasive platforms. With the increased availability of laparoscopy and multiple robotic systems, surgeons now have a choice of multiple platforms to offer patients a minimally invasive transanal resection. Multiple studies have demonstrated feasibility of using different laparoscopic and robotic platforms for TAMIS procedures; however, there has been limited comparison of outcomes amongst these systems. This study aims to compare the patient characteristics, operative factors and postoperative outcomes using three different minimally invasive surgery TAMIS platforms.

Methods/Interventions: This study was a retrospective review of patients across four hospitals in the Pacific Northwest who underwent TAMIS for benign and malignant rectal pathologies by two different colorectal surgeon physician groups. Patients were included if they underwent laparoscopic, robotic Xi, or robotic SP TAMIS between January 2019 and June of 2024. We evaluated patient demographics, operative characteristics, technical outcomes, and 30-day complication rates between procedure groups. Patient characteristics and postoperative outcomes were compared between laparoscopic, Davinci Xi robotic, and SP robotic approaches.

Results/Outcomes: A total of 126 procedures were evaluated, including 20 laparoscopic, 91 Xi robotic, and 15 SP robotic procedures. Males represented 57.1% of the population with an overall mean age of 58.79 years and mean BMI of 30.17 kg/m2. Approximately half of procedures were performed for malignancy (46.8%). The mean distance from the lesion to the anal verge was 7.7±3.7cm (L: 7.5±2.4cm, Xi: 7.7±3.4cm, SP: 7.5±6.1cm, p=0.96). Mean lesion dimension was 2.9±1.9cm (L 3.8±2.3cm, Xi: 2.7±1.8cm, SP: 2.6±3.4cm, p=0.76). Mean operating time was longest for the laparoscopic group (L: 134.5±55min, Xi: 58.1±37min, SP: 78.3 ±69min, p< 0.001). SP cases had a wider range of distances from the anal verge. There was no significant difference in rates of conversion, readmission, bleeding, or total complications. There were higher rates of urinary retention in the laparoscopic cohort, and higher rates of reoperation and specimen fragmentation in the robotic groups. One patient was found to have a recurrent adenocarcinoma two years post TAMIS procedure in the laparoscopic group.

Conclusion/Discussion: This study describes one of the largest case series comparing laparoscopic and robotic TAMIS outcomes available in the literature. Outcomes between laparoscopic, Xi, and SP TAMIS procedures were similar and had excellent outcomes across all platforms. Robotic Xi cases had shorter operative times but did have higher rates of reoperation and specimen fragmentation. The SP platform may allow for wider variations of operating distance from the anal verge. Overall, it may depend on surgeon training and preference as to what platform is preferred.