Many transanal platforms have recently evolved to manage rectal pathologies. Transanal endoscopic microsurgery (TEM) and transanal laparoscopic minimally invasive surgery (TAMIS) have been developed to address the limitations of conventional transanal surgery. More recently, the addition of the robotic platform to the surgeon's armamentarium has made it possible to combine the dexterity of the robotic surgical system with the standard TAMIS single-port platform to treat complex rectal lesions. In this article, we present the case of a patient who underwent rTAMIS for the management of a large endoscopically unresectable rectal mass.

A 62-year-old woman presents for her first screening colonoscopy as recommended by her primary care physician after an initial health maintenance examination to establish care. A 1-cm sessile polyp was found in the cecum during the colonoscopy, which was resected using hot snare polypectomy. After appropriate postprocedure recovery, the patient was sent home and presented 12 hours later to the emergency department with severe abdominal pain. CLINICAL QUESTIONS• What are the most common postcolonoscopy complications? • Are there strategies to decrease the chance of having a colonoscopy-related adverse event? • How can we manage the most frequently encountered complications?Earn Continuing Education (CME) credit online at cme.lww.com. This activity has been approved for AMA PRA Category 1 credit. TM Funding/Support: None reported.

In 2018, we described a robotic natural orifice-assisted left-sided colorectal resection with intracorporeal anastomosis and transrectal extraction of the specimen and termed it the natural orifice intracorporeal anastomosis with transrectal extraction procedure. More recently, we have explored the feasibility, safety, and utility of performing total handsewn intracorporeal anastomosis. We present a technical video and initial experience depicting the unique steps to accomplish this procedure with colorectal end-to-end handsewn anastomosis.TECHNIQUE: Twenty natural orifice intracorporeal anastomosis with transrectal extraction procedures with end-to-end handsewn intracorporeal anastomosis were performed. A video depicting the essential steps with 2 variations of the handsewn techniques is presented along with short-term outcomes. RESULTS:The most common indication was complicated diverticulitis followed by rectal cancer and deep infiltrative endometriosis of the rectum. The mean operative time was 235 minutes (99-294 min), and there were no intraoperative complications or conversions.

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