Single-port Robotic Transanal Total Mesorectal Excision in a Porcine Model (Sus scrofa domesticus)

Summary

This protocol demonstrates Single-port (SP) robotic transanal total mesorectal excision (taTME) in a porcine model, highlighting procedural feasibility, technical steps, and preclinical applicability for minimally invasive rectal surgery.

Abstract

This study presents a step-by-step protocol by using a robotic system for performing SP robotic transanal total mesorectal excision (taTME) in a porcine model. The goal is to evaluate the feasibility, procedural characteristics, and immediate postoperative outcomes of this novel approach. Compared to conventional laparoscopic and robotic systems, this technique offers potential advantages in maneuverability and visualization within the narrow pelvic space. This protocol involves sequential abdominal and transanal phases, providing clear guidance for surgical preparation, robotic docking, dissection, specimen retrieval, and anastomosis. The study includes ethical considerations and detailed intraoperative management to ensure reproducibility. Representative results demonstrate successful rectal resection without intraoperative complications. The total operative time was 140 min, including 25 min for robotic docking, 45 min for the abdominal phase, 35 min for transanal dissection, and 35 min for anastomosis and closure. Estimated blood loss was approximately 10 mL. This protocol utilized the SHURUI SP robotic system, with a dual-continuum snake-like arm design offering enhanced dexterity and instrument control in confined anatomical spaces. The described method establishes a standardized and reproducible preclinical framework, serving as a valuable platform for technical training, advanced device testing, and the refinement of SP robotic taTME protocols prior to clinical translation.

Introduction

Minimally invasive surgery has revolutionized rectal cancer treatment by reducing surgical trauma and improving postoperative recovery. TaTME provides excellent access to the deep pelvis and improves the visualization of distal resection planes^1,2. However, conventional laparoscopic taTME is limited by suboptimal ergonomics, restricted instrument mobility, and a steep learning curve within the narrow pelvic cavity³.

Recent robotic surgical systems have been developed to address these challenges and have shown promising applications in colorectal surgery

Protocol

All procedures involving animals were approved by the Institutional Animal Care and Use Committee of Daping Hospital, Army Medical University (Approval No. 2024(325)). The study was conducted in compliance with national and institutional guidelines for the care and use of laboratory animals.

1. Preoperative preparation

1. Acquire a healthy female pig (Sus scrofa domesticus) weighing approximately 65 kg from a licensed laboratory animal supplier. Confirm health status with an official veterinary health certificate.
2. Fast the animal for 12 h before surgery, allowing free access to water.
3. Administer....

Results

No significant operational problems or hurdles were encountered during the use of the SHURUI SP robotic system, and no notable intraoperative adverse events occurred. The estimated blood loss was approximately 10 mL. The total operative time was 140 min, comprising 25 min for docking, 45 min for the transabdominal phase, 35 min for the transanal phase, and 35 min for anal anastomosis and closure. These findings provide preliminary evidence supporting the feasibility and safety of performing taTME using the robotic system.......

Discussion

The successful implementation of SP robotic taTME in a porcine model demonstrates the feasibility and technical reliability of this approach. Several critical steps are essential to ensuring procedural success. Accurate placement of the transanal purse-string suture is fundamental to prevent intraluminal contamination during the proctectomy. Similarly, maintaining a stable pneumorectum is crucial for optimal visualization and precise dissection within the confined pelvic space^6,

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Lone Star Retractor System			surgical retraction device
SHURUI single-port robotic system	Beijing Surgerii Technology Co., Ltd., China	SHURUI SP (SR-ENS-600)	The Shurui single-port robotic surgical system is a novel robotic platform designed for minimally invasive surgery through a single incision. It's known for its snake-like arms and continuous deformation mechanisms, potentially offering advantages in wound appearance and flexibility compared to traditional multi-port robotic surgery or single-incision laparoscopy.
STARport	Shinaide, Xiamen, China		modified single-port robot-assisted transanal minimally invasive surgery platform