Transanal Robot-Assisted TME with Reduced Port Abdominal Laparoscopy

Abstract

Total mesorectal excision (TME) remains the gold standard in the curative surgical treatment of rectal cancer. The principle of performing a TME, obtaining a complete and intact mesorectal envelope with a negative circumferential resection margin (CRM), is the greatest predictor of locoregional control. Technical challenges to minimally invasive techniques for proctectomy leading to high conversion rates, increased operative times, and inferior pathological outcomes have prompted the development of alternative approaches. Transanal TME (TaTME) has recently evolved in the last decade as a technique in which TME is performed utilizing a perineal approach. Precise definition of the distal resection margin, clarity of lower third and anterior rectal mobilization, and ease in obese and male patients are the proposed advantages. Following the description of transanal minimally invasive surgery (TAMIS), robotic TAMIS was soon reported. Synthesis of these techniques led to the performance of robotic TaTME. Robotic TaTME with single-port abdominal colonic mobilization via the required temporary ostomy site represents an innovative, minimally invasive technique for performing curative proctectomy for rectal cancer. This technique represents advancement in the evolution of natural orifice transluminal endoscopic surgery (NOTES) for the treatment of rectal cancer, which adheres to the principle tenants of oncologic surgery.