Aim Robotic transanal minimally invasive surgery (R-TAMIS) is gaining traction around the globe as an alternative to laparoscopic conventional TAMIS for local excision of benign and early malignant rectal lesions. The aim was to analyse patient and oncological outcomes of R-TAMIS for consecutive cases in a single centre. Methods A prospective analysis of consecutive R-TAMIS procedures over a 12-month period was performed. Data were collated from hospital databases and theatre registers. Results Eleven patients (six men, five women), mean age 69.81 years (51À92 years), underwent R-TAMIS over 12 months utilizing a da Vinci Xi platform. The mean lesion size was 36 mm (20-60 mm) with a mean distance from the anal verge of 7.5 cm (3-14 cm). Five lesions were posterior in anatomical location, four anterior, one right lateral and one left lateral. All procedures were performed in the lithotomy position using a GelPOINT Path Platform. Mean operative time was 64 min (40-100 min). Complete resection was achieved in 10/11 patients with two patients being upgraded to a diagnosis of adenocarcinoma. Nine patients were diagnosed with dysplastic lesions. Four patients had a false positive diagnosis of an invasive tumour on MRI. Six patients required suturing for full-thickness resections. One patient had a postoperative bleed requiring repeat endoscopy and clipping. One patient (full-thickness resection of T3 tumour) proceeded to a formal resection without difficulty with no residual disease (T0N0, 0/22). One patient with a fully resected T2 tumour is undergoing a surveillance protocol. The mean length of stay was 1 day with two patients having a length of stay of 2 days and one patient of 4 days. Conclusion R-TAMIS could potentially represent a safe novel approach for local resection of rectal lesions.

Transanal total mesorectal excision (TaTME) is a rapidly progressing technique in the management of both benign and malignant rectal disease. It is a technical advance to the current gold-standard approach to rectal cancer, the transabdominal total mesorectal excision. Until now, T4 stage cancers have been considered a relative contraindication to TaTME due to the perceived technical difficulty and increased complication rate. This case describes the TaTME operative technique for a T4b locally advanced, mid rectal anterior tumor in a young male postneoadjuvant chemoradiation. Employing a dual team hybrid TaTME (Cecil approach) with laparoscopic abdominal assistance, this case highlights the ability of TaTME to be successfully utilized in more advanced malignancy and technically difficult patients without an increase in complications, operative time, or hospital length of stay.