Robotic TAMIS: A Technical Note Comparing Si (R) versus Xi (R)

• Transanal minimally invasive surgery (TAMIS) can be performed robotically assisted (R-TAMIS) for easier rectal defect suture closure particularly on the anterior rectal wall. The surgical technique described in this technical note emphasizes three safety points: 1) decreased likelihood for rectal injury when the ports are inserted into the GelPOINT (R) Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, California) on the back table rather than being inserted into the rectum; 2) decreased external collision between ports when using ports of different length; and 3) increased stabilization of pneumorectum when insufflating with an AirSeal (TM) port (Intelligent Flow System, ConMed, Utica, New York). Although R-TAMIS can be safely performed with the da Vinci (R) Si (R) or Xi (R) (Intuitive Surgical Inc., Sunnyvale, California) patient cart, the following differences are noteworthy: a) the Si (R) vertically-mounted arms design forces the patient in an uncomfortable position with asymmetrical hip flexion as opposed to the Xi (R) boom-mounted horizontal arm design; b) the 28cm circumference of each Si (R) patient cart arms operating between the patients legs offer decreased maneuvering freedom as opposed to the 19cm circumference of the Xi (R) counterparts; and c) the abduction pattern of movement of the Si (R) arms potentially increases the risk of external collision with the patients legs as opposed to the Xi (R) "jack-knife" pattern of movement.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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