Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art

Abstract

Total mesorectal excision (TME) is the gold standard technique for the surgical management of rectal cancer. The transanal approach to the mesorectum was introduced to overcome the technical difficulties related to the distal rectal dissection. Since its inception, interest in transanal mesorectal excision has grown exponentially and it appears that the benefits are maximal in patients with mid-low rectal cancer where anatomical and pathological features represent the greatest challenges. Current evidence demonstrates that this approach is safe and feasible, with oncological and functional outcome comparable to conventional approaches, but with specific complications related to the technique. Robotics might potentially simplify the technical steps of distal rectal dissection, with a shorter learning curve compared to the laparoscopic transanal approach, but with higher costs. The objective of this review is to critically analyze the available literature concerning robotic transanal TME in order to define its role in the management of rectal cancer and to depict future perspectives in this field of research.

Robotic Surgery in Rectal Cancer: Potential, Challenges, and Opportunities

“…Since the introduction of TaTME, it has aroused great interest in the CRC community. Several case series have suggested that TaTME is feasible and safe with regard to short-term outcomes and quality of the resected specimen, with a promising rate of CRM involvement lower than 6% [ 35 ]. However, despite its proven safety and feasibility, TaTME is still a challenging technique for most surgeons, with a longer learning curve [ 36 , 37 ••].…”

Robotic Gastrointestinal Surgery: State of the Art and Future Perspectives

“…Robotic surgery has also begun to play an important role in endoluminal surgery with the evolution of systems for transanal surgery that allow for the execution of highly complex procedures, such as RTaTME, for low-lying rectal cancer [ 5 ].…”

Editorial: Laparoscopic surgery in colorectal cancer

“…Innovations like natural orifice transluminal endoscopic surgery (NOTES), transanal total mesorectal excision (taTME), robotic surgery, and single incision laparoscopic surgery (SILS) has been developed to reach the goal of “scarless” surgery, which represents the state-of-the-art phenomenon in the field ( 3 , 4 ). Additionally, burgeoning instruments, single-incision port devices, and robot platforms open up a new scenario of CRC surgery ( 5 , 6 ).…”

“…Innovations like natural orifice transluminal endoscopic surgery (NOTES), transanal total mesorectal excision (taTME), robotic surgery, and single incision laparoscopic surgery (SILS) has been developed to reach the goal of "scarless" surgery, which represents the state-of-the-art phenomenon in the field (3, 4). Additionally, burgeoning instruments, single-incision port devices, and robot platforms open up a new scenario of CRC surgery (5,6).Under this circumstance, this Research Topic collected 9 scientific studies focused on surgical methods and experience of minimally invasive surgery, especially single incision laparoscopic surgery (SILS) and robotic surgery.A growing knowledge has revealed that port subtraction benefits CRC patients in multiple aspects without a sacrifice of operative and oncology safety. Zhang et al proved that laparoscopic right hemicolectomy (LRC) conducted through three ports harvested more lymph nodes and caused less blood loss compared with LRC performed with five ports in a retrospective clinical trial.…”