Evidence map›Paper›PMID 31350608›Full record

ArticleSurgical endoscopy2020

Feasibility of transanal total mesorectal excision (taTME) using the Medrobotics Flex® System.

Heather Carmichael, Anthony P D'Andrea, Matthew Skancke, Vincent Obias, Patricia Sylla

Abstract read
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
1.5field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 28 citations in OpenAlex.

  1. Robotic Transanal Minimally Invasive Surgery for Rectal Polyps.Clinics in colon and rectal surgery · 2024
    Review
  2. Article
  3. Article
  4. Continuum Robots for Medical Interventions.Proceedings of the IEEE. Institute of Electrical and Electronics Engineers · 2022
    Article
  5. Article
  6. Review
  7. Article
  8. Article
  9. Review
  10. The evolution of lower gastrointestinal endoscopy: where are we now?Therapeutic advances in gastrointestinal endoscopy
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Heather CarmichaelDepartment of Surgery, University of Colorado, Denver, CO, USA.
Anthony P D'AndreaDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.ORCID 0000-0002-9855-2457
Matthew SkanckeDepartment of General Surgery and Colorectal Surgery, George Washington University School of Medicine, Washington, DC, USA.
Vincent ObiasDepartment of General Surgery and Colorectal Surgery, George Washington University School of Medicine, Washington, DC, USA.
Patricia SyllaDivision of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA. patricia.sylla@mountsinai.org.
George Washington University · USIcahn School of Medicine at Mount Sinai · USUniversity of Colorado Denver · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe use of transanal total mesorectal excision (taTME) for treatment of rectal cancer is growing, but anatomic constraints prevent access to the proximal rectum with rigid instruments. The articulated instrumentation of current surgical robots is promising in overcoming these limitations, but the bulky size of current platforms inhibits the proximal reach of dissection. Flexible robotic systems could overcome these constraints while maintaining a stable platform for dissection. The goal of this study was to evaluate feasibility of performing taTME using the semi-robotic Flex® System (Medrobotics Corp., Raynham, MA) in human cadavers.

methodstaTME was performed by two surgeons in six fresh human cadaveric specimens using the Flex® System, with or without transabdominal laparoscopic assistance. Both mid- and low-rectal lesions were simulated. Metrics including quality of visualization, maintenance of pneumorectum, maneuverability of instruments, effectiveness of pursestring suture placement, and dissection in an anatomically correct plane were evaluated.

resultsThe semi-robotic endoluminal platform allowed for excellent visualization, insufflation, and dissection during taTME. Adequate pursestring occlusion of the rectum was achieved in all six cases. In cadavers with simulated mid-rectal lesions (N = 4), dissection and anterior peritoneal entry was achieved in all cases, with abdominal assistance utilized in two of four cases. In cadavers with simulated low-rectal lesions (N = 2), dissection was incomplete and aborted due to difficulty maneuvering instruments in close proximity to the rigid transanal port.

conclusionsUse of the Flex® system for taTME is feasible for mid-rectal dissection. Advantages over the traditional multi-armed robot include longer reach of instruments with the ability to dissect up to 17 cm from the anal verge, as well as tactile feedback. The current design of the flexible platform does not permit safe dissection in the distal rectum, although this constraint may be resolved with future adjustments to the equipment.

Indexed as

Transanal Endoscopic SurgeryCadaverFeasibility StudiesHumansRectumRobotic Surgical ProceduresNatural orifice transluminal endoscopic surgery (NOTES)ProctectomyRectal cancerRobotic surgeryRobotic transanal total mesorectal excisionTransanal total mesorectal excision (taTME)

Identifiers

PMID31350608
OpenAlexW2965555309

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.