Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.834
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
Processing time: 187 Days and 14 Hours
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.
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.