Robotic transanal minimally invasive surgery for local excision of rectal neoplasms (<i>Br J Surg</i> 2014; 101: 578–581)

摘要

It is difficult to predict how the future of rectal surgery will be shaped 50 years from now.It is certain, however, that the future of surgery will be shaped by the surgeons of today.Logic dictates that our journey forward will bring improvements in surgical technology.Collectively, however, our greatest achievements will lie not in the advancements themselves, but rather in the surgeon's ability to find appropriate application for them.Powered by ingenuity, and with a facility for innovation, some surgeons have found thoughtful ways to apply existing technology.This defines the very pretext of robotic transanal minimally invasive surgery (TAMIS) as described by Hompes and colleagues, who have achieved an important milestone in rectal surgery with the publication of the first cohort series of its kind.With the notable exception of transanal endoscopic microsurgery, colorectal surgeons are just beginning to explore and develop advanced transanal approaches for local and en bloc rectal resection.This includes TAMIS 1 and its robotic analogue 2 , which were borne out of a need for better operative access and precision during transanal surgery.The objective of TAMIS and robotic TAMIS is fundamental: to improve surgical quality and, in turn, clinical outcome.These unique approaches to rectal surgery were developed based on existing devices that were cleverly adapted in ways never intended by manufacturer design.The present article takes us sauntering down a pathway that leads to the future of rectal surgery.Part of the intrigue of robotic TAMIS is that it strikes a balance between the ultimate surgical marvel of the 21st century (da Vinci Surgical System  ; Intuitive Surgery, Sunnyvale, California, USA) and the most forgotten surgical innovation of the 19th century -Halsted's sterile glove.In effect, it creates a poetic synergy between hand-of-man and machine.But it was not the primary intention of the authors to find an eloquent bridge between ancient and modern centuries.Rather, by using a glove as an interface, they offset the expense of the robotic platform.In essence, this provides a partial solution to the increasingly difficult calculus of operating room economics.Robotic TAMIS using the glove port is a lesson about what one can accomplish with a little creativity and a lot of surgical prowess.As it appears, ingenuity -not research and development dollars -led to the discovery of this quite practical, low-cost interface.The melding of robot and glove represents a creative solution for robotic TAMIS.This exemplifies how, as surgeons, we have a role in leading our field forward.It is innovation such as this by today's surgeons that will shape and help define tomorrow's operating theatre.