Madrid, March 21, 2023-. The introduction of robotic surgery in minimally invasive cancer surgery has marked a before and after in the surgical approach to tumors and in the quality of life of patients. As a new milestone, MD Anderson Cancer Center Madrid has successfully performed their first minimally invasive transanal surgery with the Da Vinci robot for the removal of a rectal tumor. It is a novel surgical technique carried out in a just few hospitals in Spain.
As explained by Dr. Oscar Alonso Casado, an expert in Robotic Surgery of the Digestive System and head of Hepatobiliopancreatic Surgery at the hospital, “transanal robotic surgery or robotic TAMIS (transanal minimally invasive surgery) consists of going through the anus to be able to operate and remove rectal polyps that cannot be removed by endoscopy or early-stage rectal cancers. By means of accessories used for laparoscopy, we introduce the robot's instruments and camera through the anus removing the tumor and suturing”. This novel technique could benefit more patients with rectal cancer, a type of tumor of which it is estimated that more than 14,000 new cases will be diagnosed in 2023, according to figures from the Spanish Society of Medical Oncology (SEOM)1.
The main new aspect is being able to use the Da Vinci robot to perform transanal surgery. This has been shown to improve the ease with which removal of rectal tumors and subsequent suturing can be performed. "With the robot, we take less time to complete the operation, we can treat more complex cases with slightly larger tumors or in more difficult locations, and we are confident the results will be better because we can perform better sutures on the wall of the rectum," he explains. These benefits derive from the fact that the robot allows surgeons to see in three dimensions and its arms have a degree of mobility equal to that of the doctor's hands, practically 180º in all directions, which facilitates the application of the technique.
The aim of the procedure, indicated for the removal of tumors in very early stages, is to cure the patient. If removal is performed correctly, no other treatment is required in the short term, hence the importance of being able to fully remove the tumor, with adequate margins, with the help of precise robotic surgery equipment.
To ensure the safety of the technique, Dr. Alonso's multidisciplinary team first developed an experimental model to verify the feasibility of applying robotic surgery in this procedure with optimum safety for patients. “Having seen how successful the technique has been and that the patient, who left the hospital after three days of recovery, is progressing very favorably, our next step will be to expand the use of robotic TAMIS and compile a representative sample of patients to check if the results are better than those with other surgical techniques”.
Development of robotic surgery at MD Anderson Madrid
The hospital acquired the Da Vinci Xi robotic platform in 2019 and it has since been used in the treatment of colorectal cancer, with many patients having already benefited from the advantages of robotic surgery in their recovery and prognosis.
As Dr. Alonso Casado states, “we offer robotic surgery to all patients at the center with colorectal cancer for whom this type of intervention is indicated and have achieved very good results. We have been able to reduce the average hospital stay and have not had to resort to open surgery with any of our patients. Furthermore, we have maintained oncological quality standards in terms of numbers of lymph nodes removed, adequate margins or complication rates, among other indicators”.
1. Sociedad Española de Oncología Médica (SEOM). Las cifras del cáncer en España en 2023: https://seom.org/images/Las_cifras_del_Cancer_en_Espana_2023.pdf