Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 834-847
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.834
Robotic transanal total mesorectal excision: Is the future now?
Juan Carlos Sebastián-Tomás, Aleix Martínez-Pérez, Elías Martínez-López, Nicola de'Angelis, Marcos Gómez Ruiz, Eduardo García-Granero
Juan Carlos Sebastián-Tomás, Elías Martínez-López, Eduardo García-Granero, Department of Surgery, Universidad de Valencia, Valencia 46010, Spain
Juan Carlos Sebastián-Tomás, Elías Martínez-López, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia 46017, Spain
Aleix Martínez-Pérez, Faculty of Health Sciences, Valencian International University, Valencia 46002, Spain
Aleix Martínez-Pérez, Nicola de'Angelis, Minimally Invasive and Robotic Digestive Surgery Unit, Miulli Hospital, Acquaviva delle Fonti 70021, Italy
Marcos Gómez Ruiz, Department of General and Digestive Surgery, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
Marcos Gómez Ruiz, Grupo de Investigación en Innovación Quirúrgica, Instituto de Investigación Biomédica Valdecilla (IDIVAL), Santander 39008, Spain
Eduardo García-Granero, Department of General and Digestive Surgery, Hospital Universitario y Politécnico la Fe, Valencia 46026, Spain
Author contributions: Sebastián-Tomás JC, Martínez-Pérez A, and García-Granero E contributed to conception and design of the work; all authors drafted the manuscript and critical revised it for important intellectual content; all authors approve the final version.
Conflict-of-interest statement: Gómez Ruiz M received grants from Intuitive Surgical and Medtronic and currently is Medical Advisor to Intuitive Surgical, Medtronic, and Johnson & Johnson. The rest of the authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Aleix Martínez-Pérez, MD, PhD, Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla 21, Valencia 46002, Spain.
Received: February 13, 2021
Peer-review started: February 13, 2021
First decision: March 16, 2021
Revised: March 22, 2021
Accepted: July 7, 2021
Article in press: July 7, 2021
Published online: August 27, 2021

Total mesorectal excision (TME) is the standard surgical treatment for the curative radical resection of rectal cancers. Minimally invasive TME has been gaining ground favored by the continuous technological advancements. New procedures, such as transanal TME (TaTME), have been introduced to overcome some technical limitations, especially in low rectal tumors, obese patients, and/or narrow pelvis. The earliest TaTME reports showed promising results when compared with the conventional laparoscopic TME. However, recent publications raised concerns regarding the high rates of anastomotic leaks or local recurrences observed in national series. Robotic TaTME (R-TaTME) has been proposed as a novel technique incorporating the potential benefits of a perineal dissection together with precise control of the distal margins, and also offers all those advantages provided by the robotic technology in terms of improved precision and dexterity. Encouraging short-term results have been reported for R-TaTME, but further studies are needed to assess the real role of the new technique in the long-term oncological or functional outcomes. The present review aims to provide a general overview of R-TaTME by analyzing the body of the available literature, with a special focus on the potential benefits, harms, and future perspectives for this novel approach.

Keywords: Rectal cancer, Minimally-invasive surgery, Robotics, Total mesorectal excision, Transanal approach, Natural orifice surgery

Core Tip: Rectal cancer management has been an issue of concern and discussion during the last 40 years. Total mesorectal excision (TME) has been considered the paradigm for its surgical treatment, while new minimally invasive approaches to perform TME have been introduced and expanded worldwide. Transanal TME could provide better control of the distal margins in technically complex low rectal tumors, but its oncological safety remains controversial. In this review, we discuss the current status of robotic transanal TME, including technical aspects, short- and long-term outcomes, as well as the foreseeable future marked by the improvements on robotic platforms and real-time navigation.