Transanal excision of rectal lesions using a single port robot: outcomes of initial 81 resections.

Transanal excision of rectal lesions remains challenging due to limitations in visualization and access to the cephalad margin, often resulting in high rates of piecemeal excision and positive margins. Transanal Minimally Invasive Surgery (TAMIS), developed using laparoscopic instruments, aimed to improve transanal exposure and reach. We present our experience with single-port robotic TAMIS (SP rTAMIS) to assess its safety and efficacy. A prospectively maintained database of SP robotic colorectal resections performed between October 2018 to September 2024 was retrospectively reviewed to identify all SP rTAMIS operations performed. Cases were analyzed regarding peri-operative outcomes to determine the efficiency and safety of this operation. A total of 81 SP rTAMIS operations were performed. Men comprised 59% of the patients. Tumor characteristics were (mean/range): size 3.56 cm (1–8), inferior level 4.96 cm (0–30), cephalad margin 8.8 cm (2–35). Preoperative diagnoses included: cancer 41, adenoma 34, other 6. Average EBL was 33 cc (0–250) with a median of 10 cc. There were no transfusions. Conversion to an alternative approach occurred in 3.7% of cases. Piecemeal excision rate was 1.23%. There were no positive margins. Overall morbidity was 7.4%. There were no mortalities. Mean follow-up time was 15.3 months (0–32.3 months). Local recurrence was 1.23%. SP rTAMIS was found to be an excellent option for transanal resection of rectal lesions in this initial series. It enabled safe en-bloc resection and primary closure with low positive margin rates and subsequently low local recurrence rates. SP rTAMIS offers the promise to extend the application of endoluminal transanal surgery, although further studies are warranted.