Robot-Assisted TME with Coloanal Anastomosis

Abstract

Since total mesorectal excision (TME) was introduced in 1982 [1], it has become a standard procedure for the treatment of rectal cancer. For low rectal cancer, coloanal anastomosis (CAA) [2] after ultralow anterior resection (uLAR) or intersphincteric resection (ISR) [3] along with TME has provided positive functional, psychological, and oncological outcomes. These outcomes of surgical techniques are also owed to the development of anatomical knowledge and perioperative treatment [4]. Robotic systems offer surgeons several benefits, though there have been controversial issues. Recent reports have indicated that robotic surgery is feasible and safe compared to laparoscopic surgery [5, 6, 7]. Robotic surgery enables easier performance of intersphincteric dissection for very low-lying rectal cancer, especially when accompanied with unfavorable factors such as high body mass index or preoperative radiation, leading to satisfactory surgical, functional, and oncological outcomes compared to conventional laparoscopy [8]. It also provides earlier recovery of sexual and bladder functions [6], lower conversion rate, and shorter hospital stay [9]. Although multicenter, randomized prospective trials are needed, robot-assisted TME with CAA with or without ISR has potential benefits for low rectal cancer.