A Comparison of the Laparoscopic vs Robotic Approaches for Transanal Minimally Invasive Surgery (TAMIS)

Abstract

Introduction Transanal minimally invasive surgery (TAMIS) is a technique used for the management of low rectal neoplasms in properly selected patients. Transanal minimally invasive surgery may be performed using either laparoscopic or robotic platforms. Little data exists in the literature comparing the two. We hypothesize that the use of the robotic platform will facilitate superior outcomes due the advantages of the robotic platform in terms of its superior maneuverability, ease of suturing, and 3-dimensional visualization. Methods This retrospective study included adults who underwent a TAMIS via a robotic or laparoscopic approach in a rural tertiary care hospital between January 2016 and December 2023. Following IRB approval, patients who underwent TAMIS were identified using CPT codes 45171, 45172, 0184T, and S2900. Chart review was performed comparing approaches. Variables included patient demographics, operative time, blood loss, need for reoperation, presence of positive margins, and cost. Outcomes were compared using Fisher’s Exact and Mann-Whitney U-tests (SPSS version 22.0, IBM, Armonk NY). Results Twenty-seven patients met inclusion criteria (19 laparoscopic and 8 robotic). Both groups did not differ significantly in age (65.47 ± 12.16 vs 54.75 ± 19.09, P = 0.26) and sex (male, 73.7% vs 75.0%, P = 1.00). Outcomes did not differ statistically across the two groups with respect to operative time (1.54 ± 0.58 vs 1.35 ± 0.22 hours, P = 0.33), blood loss (89.5% minimal vs 100.0% minimal, P = 1.00), and incidence of positive margins (10.5% vs 12.5%, P = 1.00). The cost of the laparoscopic TAMIS was significantly lower ($2271/case vs $15,948/case, P < 0.001) compared to the robotic TAMIS approach. Conclusions Laparoscopic and robotic TAMIS yield comparable results, but the laparoscopic approach is much less costly. Prospective studies comparing surgical outcomes and procedural costs are therefore warranted.