Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision

Summary

Robot-assisted natural orifice specimen extraction surgery is a minimally invasive technique that combines robotic precision with natural orifice specimen extraction. A 67-year-old patient successfully underwent the procedure in 290 min, with minimal bleeding and no residual cancer. This approach minimized abdominal trauma, reduced complications, and enabled a quick recovery.

Abstract

Robot-assisted natural orifice specimen extraction surgery (NOSES) for sigmoid colon cancer represents an innovative, minimally invasive surgical technique that integrates the benefits of minimally invasive surgery with natural orifice specimen extraction. In this study, a 67-year-old male patient diagnosed with sigmoid colon cancer underwent Kangduo surgical robot-assisted NOSES, with a total operative time of 290 min and an estimated intraoperative blood loss of 50 mL. The procedure involved robotic-assisted radical resection of the sigmoid colon, regional lymphadenectomy, and specimen extraction through a natural orifice. Postoperative histopathological analysis confirmed the absence of residual malignancy in the resected sigmoid colon, while 12 pericolic lymph nodes exhibited reactive hyperplasia. Both the proximal and distal surgical margins were negative for malignancy. The patient had an uneventful recovery and was discharged on postoperative day 7. The precision and flexibility of the robotic system facilitated NOSES by minimizing abdominal wall trauma, reducing postoperative complications, and shortening recovery time. This finding indicates that robot-assisted NOSES is a safe and feasible approach for the surgical treatment of sigmoid colon cancer, though further clinical experience and long-term follow-up are required to comprehensively assess its efficacy.

Introduction

Natural Orifice Specimen Extraction Surgery (NOSES) is an innovative advancement in minimally invasive surgical techniques, offering the advantage of avoiding abdominal wall incisions for specimen extraction. This approach integrates the benefits of laparoscopic or robotic surgery with specimen extraction through natural orifices, thereby reducing surgical trauma, minimizing postoperative pain, and facilitating faster recovery¹.

Robot-assisted surgery has revolutionized the field of minimally invasive procedures by enhancing precision, dexterity, and visualization through robotic systems². The....

Protocol

This protocol was performed in line with the principles of the Declaration of Helsinki. The protocol followed the guidelines of the local institution's human research ethics committee and was approved by the local institutional review board (2022-45, September 29, 2022). The patient provided informed consent to participate in the study and for the publication of their anonymized case details and images.

1. Patient positioning and trocar layout

1. Position the patient in a modified lithotomy position with the head tilted 15-30° lower than the feet to achieve the Trendelenburg position. Perform the sterile p....

Results

The patient successfully underwent a Kangduo robot-assisted transanal specimen extraction radical sigmoidectomy without an auxiliary abdominal incision (NOSES-IV). The procedure lasted approximately 290 min, with an intraoperative blood loss of 50 mL. No operative complications and blood transfusions were required. The surgical specimen is shown in Figure 4. On the first postoperative day, the patient passed anal flatus, tolerated oral liquid intake, and walked independently. By the second p.......

Discussion

Currently, surgical intervention is widely acknowledged as the primary therapeutic approach for managing colorectal cancer. The growing adoption of robotic systems in various surgical specialties, including colorectal, gastrointestinal, cardiothoracic, and gynecologic surgery, is driven by the increasing emphasis on minimally invasive techniques and continuous advancements in robotic platform technology. Compared to conventional laparoscopic surgery, surgical robot systems offer several advantages, such as high-definitio.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Bipolar coagulation forceps	Sagebot(Harbin,  China)	0701	Operation
Disposable Three-row-stapler Circular Stapler	Waston Medical(Changzhou,China)	IIIROWS-29-D	Laparoscopic Surgical Stapler
Fenestrated grasper	Sagebot(Harbin,  China)	301	Operation
Kangduo-SR-01 Surgical Robot	Sagebot(Harbin,  China)	KD-SR-01	Endoscopic surgical robot
Laparoscopic single use linear cutter	Ethicon (Somerville, NJ)	PSEE60A	Laparoscopic Surgical Stapler
Sterile protective cover	Sagebot(Harbin,  China)	M003-005;H001	Sterile barrier
STRATAFIX Spiral PGA-PCL	Ethicon (Somerville, NJ)	SXMD1B405	Reinforced suture
Trocars	Sagebot(Harbin,  China)	NA	Surgical ports