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  1. Article ; Online: Same-day colectomy: are we throwing caution to the wind?

    Atallah, S B / Larach, S W

    Techniques in coloproctology

    2023  Volume 27, Issue 12, Page(s) 1137–1138

    Language English
    Publishing date 2023-09-19
    Publishing country Italy
    Document type Editorial
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-023-02861-8
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  2. Article ; Online: Envisioning the future of colorectal surgery: preclinical assessment and detailed description of an endoluminal robotic system (ColubrisMX ELS).

    Atallah, S / Sanchez, A / Bianchi, E / Larach, S W

    Techniques in coloproctology

    2021  Volume 25, Issue 11, Page(s) 1199–1207

    Abstract: Background: The EndoLuminal Surgical System (ELS) is an emerging non-linear robotic system specifically designed for transanal surgery that allows for excision of colorectal neoplasia and luminal defect closure.: Methods: An evaluation of ELS was ... ...

    Abstract Background: The EndoLuminal Surgical System (ELS) is an emerging non-linear robotic system specifically designed for transanal surgery that allows for excision of colorectal neoplasia and luminal defect closure.
    Methods: An evaluation of ELS was conducted by a single surgeon in a preclinical setting at the EndoSurgical Center of Florida in Orlando, between October 1st, 2020 and December 31st, 2020, using porcine colon as a model. Mock lesions measured 2.5 to 3.5 cm were excised partial-thickness. Specimen quality and excision time was assessed and evaluated.
    Results: Twenty consecutive robotic transanal minimally invasive surgery (TAMIS) operations utilizing the ELS system were successfully performed without fragmentation. The mean and standard deviation procedure time for all 20 cases was 18.41 ± 14.15 min. The latter 10 cases were completed in substantially less time, suggesting that ELS requires at least 10 preclinical cases for a surgeon to become familiar with the technology. A second task, namely suture closure of the partial-thickness defect, was performed in 9 of the 20 cases. Mean time and standard deviation for this task measured 27.89 ± 10.07 min. There were no adverse events.
    Conclusions: ELS was successful in performing the tasks of partial-thickness disc excision and closure in a preclinical evaluation. Further study is necessary to determine its clinical applicability.
    MeSH term(s) Colorectal Surgery ; Humans ; Rectal Neoplasms ; Rectum ; Robotic Surgical Procedures ; Transanal Endoscopic Surgery
    Language English
    Publishing date 2021-07-05
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-021-02481-0
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  3. Article ; Online: A new approach to rectal prolapse repair - perineal proctectomy with transanal minimally invasive surgery rectopexy and mesh fixation - a video vignette.

    Atallah, S / Dakermandji, M / Larach, S W

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2019  Volume 21, Issue 5, Page(s) 609–610

    MeSH term(s) Humans ; Proctectomy/methods ; Rectal Prolapse/surgery ; Surgical Mesh ; Transanal Endoscopic Surgery/methods
    Language English
    Publishing date 2019-04-03
    Publishing country England
    Document type Letter ; Video-Audio Media
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.14620
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  4. Article ; Online: Robotic TAMIS for local excision of ultra-distal neoplasia.

    Shuck, R L / Larach, S W / Atallah, S

    Techniques in coloproctology

    2019  Volume 23, Issue 4, Page(s) 395

    MeSH term(s) Humans ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectum/pathology ; Rectum/surgery ; Robotic Surgical Procedures/methods ; Transanal Endoscopic Surgery/methods
    Language English
    Publishing date 2019-04-15
    Publishing country Italy
    Document type Journal Article ; Video-Audio Media
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-019-01975-2
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  5. Article ; Online: Direct target NOTES: prospective applications for next generation robotic platforms.

    Atallah, S / Hodges, A / Larach, S W

    Techniques in coloproctology

    2018  Volume 22, Issue 5, Page(s) 363–371

    Abstract: Background: A new era in surgical robotics has centered on alternative access to anatomic targets and next generation designs include flexible, single-port systems which follow circuitous rather than straight pathways. Such systems maintain a small ... ...

    Abstract Background: A new era in surgical robotics has centered on alternative access to anatomic targets and next generation designs include flexible, single-port systems which follow circuitous rather than straight pathways. Such systems maintain a small footprint and could be utilized for specialized operations based on direct organ target natural orifice transluminal endoscopic surgery (NOTES), of which transanal total mesorectal excision (taTME) is an important derivative.
    Methods: During two sessions, four direct target NOTES operations were conducted on a cadaveric model using a flexible robotic system to demonstrate proof-of-concept of the application of a next generation robotic system to specific types of NOTES operations, all of which required removal of a direct target organ through natural orifice access. These four operations were (a) robotic taTME, (b) robotic transvaginal hysterectomy in conjunction with (c) robotic transvaginal salpingo-oophorectomy, and in an ex vivo model, (d) trans-cecal appendectomy.
    Results: Feasibility was demonstrated in all cases using the Flex
    Conclusions: A flexible robotic system has the potential to access anatomy along circuitous paths, making it a suitable platform for direct target NOTES. The conceptual operations posed could be considered suitable for next generation robotics once the technology is optimized, and after further preclinical validation.
    MeSH term(s) Appendectomy/methods ; Cadaver ; Cecum/surgery ; Female ; Humans ; Hysterectomy, Vaginal/methods ; Male ; Rectum/surgery ; Robotic Surgical Procedures/methods ; Salpingo-oophorectomy/methods ; Transanal Endoscopic Surgery/methods ; Vagina/surgery
    Language English
    Publishing date 2018-05-31
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-018-1788-z
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  6. Article ; Online: Towards the development of simultaneous two-field robotic surgery.

    Atallah, S / DuBose, A / Larach, S W

    Techniques in coloproctology

    2016  Volume 20, Issue 1, Page(s) 71–73

    MeSH term(s) Humans ; Laparoscopy/methods ; Photography ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/instrumentation ; Robotic Surgical Procedures/methods ; Transanal Endoscopic Surgery/instrumentation ; Transanal Endoscopic Surgery/methods
    Language English
    Publishing date 2016-01
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-015-1403-5
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  7. Article ; Online: Robotic-assisted stereotactic real-time navigation: initial clinical experience and feasibility for rectal cancer surgery.

    Atallah, S / Parra-Davila, E / Melani, A G F / Romagnolo, L G / Larach, S W / Marescaux, J

    Techniques in coloproctology

    2019  Volume 23, Issue 1, Page(s) 53–63

    Abstract: Background: Real-time stereotactic navigation for transanal total mesorectal excision has been demonstrated to be feasible in small pilot series using laparoscopic techniques. The possibility of real-time stereotactic navigation coupled with robotics ... ...

    Abstract Background: Real-time stereotactic navigation for transanal total mesorectal excision has been demonstrated to be feasible in small pilot series using laparoscopic techniques. The possibility of real-time stereotactic navigation coupled with robotics has not been previously explored in a clinical setting.
    Methods: After pre-clinical assessment, and configuration of a robotic-assisted navigational system, two patients with locally advanced rectal cancer were selected for enrollment into a pilot study designed to assess the feasibility of navigation coupled with the robotic da Vinci Xi platform via TilePro interface. In one case, fluorescence-guided surgery was also used as an adjunct for structure localization, with local administration of indocyanine green into the ureters and at the tumor site.
    Results: Each operation was successfully completed with a robotic-assisted approach; image-guided navigation provided computed accuracy of ± 4.5 to 4.6 mm. The principle limitation encountered was navigation signal dropout due to temporary loss of direct line-of-sight with the navigational system's infrared camera. Subjectively, the aid of navigation assisted the operating surgeon in identifying critical anatomical planes. The combination of fluorescence with image-guided surgery further augmented the surgeon's perception of the operative field.
    Conclusions: The combination of stereotactic navigation and robotic surgery is feasible, although some limitations and technical challenges were observed. For complex surgery, the addition of navigation to robotics can improve surgical precision. This will likely represent the next step in the evolution of robotics and in the development of digital surgery.
    MeSH term(s) Adult ; Aged ; Feasibility Studies ; Female ; Humans ; Laparoscopy/methods ; Male ; Medical Illustration ; Neuronavigation/methods ; Pilot Projects ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/methods ; Stereotaxic Techniques ; Surgery, Computer-Assisted/methods
    Language English
    Publishing date 2019-01-17
    Publishing country Italy
    Document type Case Reports ; Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-018-1914-y
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  8. Article ; Online: Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient?

    Atallah, S / Maharaja, G K / Martin-Perez, B / Burke, J P / Albert, M R / Larach, S W

    Techniques in coloproctology

    2016  Volume 20, Issue 7, Page(s) 461–466

    Abstract: Background: Approximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is ...

    Abstract Background: Approximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment for symptomatic hemorrhoids, and outcomes with patients on anticoagulation who have undergone this procedure have not been previously reported. Here, we report our preliminary results of patients who underwent THD while on anticoagulation.
    Methods: During a 53-month period (February 2009-July 2015), patients with symptomatic hemorrhoids refractory to medical management who underwent surgical treatment with THD were retrospectively reviewed. The subset of patients who underwent THD while anticoagulated was compared to a cohort of patient who were not taking anticoagulation and who otherwise demonstrated normal coagulation profiles and who did not have a known predisposition to bleeding or inherited coagulopathy. The primary study endpoint was to assess postoperative bleeding in patients who were maintained on anticoagulation before and after surgery.
    Results: During the 53-month study period, 106 patients underwent the THD procedure for symptomatic hemorrhoids. Of these, seventy patients underwent THD without anticoagulation therapy, while 36 patients underwent THD while taking one or more oral anticoagulants. The postoperative morbidity between the two cohorts was similar, and specifically there was no statistical difference in the rate of postoperative hemorrhage (19.4 vs. 15.7 %; odds ratio 1.295, 95 % CI 0.455-3.688, p = 0.785). No patient, in either cohort, required re-intervention for any reason during the study period. Patients who underwent THD while on anticoagulation were less likely to have recurrent hemorrhoidal disease during the study's 6-month median follow-up period (2.8 vs. 7.1 %, p = 0.049).
    Conclusions: These preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.
    MeSH term(s) Adult ; Aged ; Anticoagulants/therapeutic use ; Blood Loss, Surgical ; Female ; Hemorrhoidectomy/adverse effects ; Hemorrhoidectomy/methods ; Hemorrhoids/surgery ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Hemorrhage/etiology ; Recurrence ; Retrospective Studies ; Transanal Endoscopic Surgery/adverse effects
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2016-07
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-016-1481-z
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  9. Article: Complications of laparoscopic surgery for rectal cancer: avoidance and management.

    Larach, S W / Gallagher, J T

    Seminars in surgical oncology

    2000  Volume 18, Issue 3, Page(s) 265–268

    Abstract: Since laparoscopy was first introduced as a diagnostic tool for pelvic pathology 15 years ago, the technique has been successfully adapted by general and specialty surgeons as a therapeutic tool for a variety of diseases. Laparoscopic surgery has been ... ...

    Abstract Since laparoscopy was first introduced as a diagnostic tool for pelvic pathology 15 years ago, the technique has been successfully adapted by general and specialty surgeons as a therapeutic tool for a variety of diseases. Laparoscopic surgery has been used to treat colon and rectal pathology since 1991. The introduction and acceptance of this new access technique also brought the realization of specific complications associated with a laparoscopic approach. Advanced laparoscopic skills are required for laparoscopic pelvic and, to minimize laparoscopic-associated complications, specialized training is required. We will review the specific complications of the laparoscopic approach in pelvic surgery with a view to their recognition, prevention, and treatment.
    MeSH term(s) Burns, Electric/prevention & control ; Dissection ; Humans ; Intestines/injuries ; Laparoscopy/adverse effects ; Pelvis/surgery ; Pneumoperitoneum, Artificial/adverse effects ; Postoperative Complications/prevention & control ; Rectal Neoplasms/surgery ; Ureter/injuries ; Urinary Bladder/injuries ; Venous Thrombosis/prevention & control
    Language English
    Publishing date 2000-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632539-7
    ISSN 1098-2388 ; 8756-0437
    ISSN (online) 1098-2388
    ISSN 8756-0437
    DOI 10.1002/(sici)1098-2388(200004/05)18:3<265::aid-ssu11>3.0.co;2-0
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  10. Article ; Online: Robotic TransAnal Minimally Invasive Surgery in a cadaveric model.

    Atallah, S B / Albert, M R / deBeche-Adams, T H / Larach, S W

    Techniques in coloproctology

    2011  Volume 15, Issue 4, Page(s) 461–464

    Abstract: The technique of TransAnal Minimally Invasive Surgery (TAMIS) was pioneered in 2009 as a hybrid approach to endoluminal resections of appropriately selected rectal lesions. There are, however, limitations to performing this type of resection. Robotic ... ...

    Abstract The technique of TransAnal Minimally Invasive Surgery (TAMIS) was pioneered in 2009 as a hybrid approach to endoluminal resections of appropriately selected rectal lesions. There are, however, limitations to performing this type of resection. Robotic TAMIS is a novel, experimental technique and in this study was performed in a cadaveric model at a surgical education center. Various tasks were carried out using robotic TAMIS, including full-thickness sharp and cautery excision of rectal wall, as well as intra-luminal suturing of the surgical defect. It was found that for the da Vinci-trained surgeon, these tasks were simple to perform and accomplished with greater precision when compared to standard TAMIS. Our initial results indicate that robotic TAMIS overcomes the limitations of standard TAMIS and that it is a feasible platform for transanal surgery. The cost, however, of performing robotic TAMIS may limit its application to special cases in which standard TAMIS or transanal endoscopic microsurgery resections may prove difficult. Further study is necessary to validate these preliminary findings before robotic TAMIS is performed on live patients.
    MeSH term(s) Anal Canal ; Cadaver ; Equipment Design ; Humans ; Natural Orifice Endoscopic Surgery/methods ; Rectal Neoplasms/surgery ; Robotics/instrumentation
    Keywords covid19
    Language English
    Publishing date 2011-09-28
    Publishing country Italy
    Document type Comparative Study ; Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-011-0762-9
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