Single-port Robotic Transanal Total Mesorectal Excision in a Porcine Model (Sus scrofa domesticus)
April 3rd, 2026
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.
This research focuses on evaluating a novel single port robotic platform for transanal rectal surgery and assessing its feasibility in a porcine model. Current robotic transanal total mesorectal excision systems are limited by high costs and availability. This protocol introduces a flexible, cost-effective alternative platform.
After preparing a healthy female pig for the procedure, identify the inferior mesenteric artery, skeletonize the vessels, and perform lymphadenectomy at its root, using electrocautery cautiously to minimize thermal damage to surrounding tissues. Clip and divide the inferior mesenteric artery distal to the origin of the left colic artery, while preserving the left colic artery to maintain blood supply to the proximal colon. Then mobilize the sigmoid colon by dissecting along the mesocolic plane.
Continue mobilization of the descending colon along the same plane. Perform pelvic dissection following the mesorectal plane, and continue dissection down to the level of the peritoneal reflection. Once the animal is prepared for robotic transanal phase, perform a full thickness circumferential proctectomy, 1.0 centimeters distal to the purse string suture.
Enter the mesorectal plane and initiate bottom up dissection. Dissect posteriorly along the avascular plane toward the sacrum. Continue lateral dissection while carefully preserving the neurovascular bundles.
Proceed anteriorly to separate the rectum from adjacent pelvic structures. Then extend the dissection cranially toward the peritoneal reflection. Extract the resected rectum and mesorectum transanally through the access port.
Perform a hand-sewn coloanal anastomosis under direct visualization using interrupted absorbable sutures followed by closure of the abdominal incision. This protocol measures robotic transanal total mesorectal excision feasibility, operative time, blood loss, and short-term outcomes. A key challenge during this protocol is the persistent risk of urethral injury during anterior dissection, despite robotic assistance.
View the full transcript and gain access to thousands of scientific videos
Overview
This study introduces a detailed protocol for performing single-port (SP) robotic transanal total mesorectal excision (taTME) using a porcine model. The protocol leverages the SHURUI SP robotic system to assess the feasibility, procedural workflow, and immediate outcomes of this innovative surgical approach. The method aims to enhance maneuverability and visualization in the narrow pelvic space, offering a reproducible framework for preclinical research and surgical training.
Key Study Components
Area of Science
- Robotic surgery
- Colorectal surgery
- Preclinical surgical models
Background
- Transanal total mesorectal excision (taTME) is a technique for rectal cancer surgery.
- Conventional laparoscopic and robotic systems face challenges in maneuverability within the pelvis.
- Single-port robotic systems may offer improved dexterity and visualization in confined spaces.
- Preclinical models are essential for protocol development and technical training.
Purpose of Study
- To establish a step-by-step protocol for SP robotic taTME in a porcine model.
- To evaluate the feasibility and procedural characteristics of this approach.
- To document immediate postoperative outcomes and intraoperative management.
Methods Used
- Utilization of the SHURUI SP robotic system with a dual-continuum snake-like arm design.
- Sequential abdominal and transanal surgical phases.
- Detailed steps for surgical preparation, robotic docking, dissection, specimen retrieval, and anastomosis.
- Ethical considerations and intraoperative management protocols.
Main Results
- Successful rectal resection was achieved without intraoperative complications.
- Total operative time was 140 minutes, including 25 minutes for robotic docking, 45 minutes for the abdominal phase, 35 minutes for transanal dissection, and 35 minutes for anastomosis and closure.
- Estimated blood loss was approximately 10 mL.
- The protocol demonstrated enhanced dexterity and instrument control in the narrow pelvic space.
Conclusions
- The described protocol is feasible and reproducible in a porcine model.
- SP robotic taTME offers potential advantages in maneuverability and visualization over conventional systems.
- This method provides a valuable platform for technical training, device testing, and further refinement before clinical application.
Frequently Asked Questions
Executive Industry Relevance
Single-port robotic transanal total mesorectal excision (taTME) in a porcine model establishes a reproducible preclinical framework for evaluating advanced surgical robotics in confined anatomical spaces. This protocol enables technical training, device optimization, and workflow standardization prior to clinical translation, directly supporting innovation in minimally invasive surgical platforms. The approach enhances predictive confidence for device performance and procedural feasibility at critical preclinical inflection points.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables rigorous assessment of robotic system maneuverability and visualization in anatomically relevant models.
- Supports functional validation of device design and control mechanisms in complex surgical environments.
- Facilitates mechanistic de-risking of new surgical technologies before clinical application.
Screening & Assay Development
- Provides a standardized, reproducible platform for evaluating surgical device prototypes and procedural workflows.
- Enables quantitative measurement of operative time, blood loss, and intraoperative outcomes for comparative analysis.
- Supports reproducibility and scalability in preclinical device testing and technical training.
Translational & Preclinical Research
- Aligns preclinical procedural outcomes with translational endpoints relevant to human surgical applications.
- Establishes continuity from device concept through preclinical validation, supporting risk-adjusted advancement decisions.
- Offers a platform for iterative refinement of robotic protocols and instrumentation.
Pipeline & Workflow Integration
This protocol positions single-port robotic taTME within the preclinical discovery-to-validation continuum, bridging device engineering and translational research.
- Discovery Biology: Supports hypothesis testing for robotic system performance in anatomically constrained environments.
- Screening: Delivers reproducible, quantitative outputs for device and workflow benchmarking.
- Analytics: Enables measurement of operative metrics and immediate procedural outcomes for cross-comparison.
- Translational Research: Provides a preclinical foundation for aligning device capabilities with clinical requirements.
- Enterprise Reuse: Establishes a reusable model for ongoing device evaluation and surgical training initiatives.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in device feasibility and procedural reproducibility.
- Operational Value: Standardizes preclinical workflows and supports scalable technical training.
- Strategic Value: Informs go/no-go decisions for device advancement and protocol refinement.
- Portfolio Impact: Enables risk-adjusted prioritization of surgical robotics projects in R&D pipelines.
Implementation Considerations
- Requires expertise in robotic surgery and preclinical model management.
- Demands access to advanced robotic instrumentation and surgical suites.
- Necessitates standardized protocols for reproducibility across research teams.
- May require adaptation for different anatomical models or device platforms.
- Immediate outcomes are limited to procedural feasibility and do not address long-term endpoints.