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.
Highlights
Total mesorectal excision (TME) is the standard procedure in the surgical treatment of rectal cancer [1]
In the last two decades this technique has revolutionized the results of rectal cancer surgery, demonstrating how surgical quality has a direct impact on local control and survival [2,3], the circumferential radial margin (CRM) and the integrity of mesorectal envelope being independent predictors of local recurrence [4,5,6]
transanal TME (TaTME) can be considered a real game-changer in the surgical management of rectal cancer
Summary
Total mesorectal excision (TME) is the standard procedure in the surgical treatment of rectal cancer [1]. The occurrence of urethral injury, a serious complication directly related to the transanal phase of the operation, [10] and recent evidence of the higher involvement of the distal resection margin (DRM) when compared with a robotic low anterior resection [18] underline how relevant are a deep knowledge of pelvic anatomy and the acquisition of advanced surgical skills In this light, the introduction of robotic technology with a stable 3D vision may offer the possibility of performing very complex tasks with ambidextrous movements, decreasing tremor and improved dexterity, allowing a better dissection, especially in confined surgical fields [19]. All these advantages would potentially help overcome the steep learning curve related to the complexity of TaTME, making robotic assistance a gold standard for this approach
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