LAUSR

Precision has always been a cornerstone of robotic surgery, with the idea being that if dissection is more exact, the improvement in operative quality will translate into superior clinical outcomes. The advantage of precision-based local excision of rectal neoplasia has been proven [1]; whether performed by transanal minimally invasive surgery (TAMIS) [2] or by transanal endoscopic microsurgery (TEM) [3] the outcome remains the same [4]. Introduced in 2011, robotic TAMIS was proposed as a technique which could be applied toward local excision of rectal neoplasia, and preliminary data confirm feasibility and acceptable outcomes [5, 6]. Such a natural orifice approach, utilizing robotics, likely represents a key target application for next-generation computer-enhanced surgical systems [7, 8]. In this video forum, the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) in conjunction with TAMIS access is used as a platform to excise a rectal neoplasm which encroaches on the anterior anal verge. The technical challenges posed by ultra-distal access and exposure, as well as the general principles of TAMIS-based robotic local excision, are detailed.