Robotic transanal total mesorectal excision: Is the future now?

Table 1 Technical details of the series reporting robotic transanal total mesorectal excision

Ref.	Period of study	n	Robotic platform	Transanal interface	Patients' position	Type of Robotic TaTME	Teams	Remarks
Atallah et al[25], 2013		11	da Vinci Si	GelPOINT path	Dorsal lithotomy	Robotic-assisted	1	1st robotic TaTME
Verheijen et al[26], 2014		1	da Vinci	GelPOINT path	Lithotomy	Robotic-assisted	1
Gómez Ruiz et al[29], 2015	August 2013 January 2014	5	da Vinci Si	Transanal	Lithotomy	Totally robotic	1	1st totally robotic TaTME
				Access Port +
				GelPOINT
Atallah et al[30], 2015	November 2011 August 2014	4	da Vinci Si	GelPOINT path	Dorsal lithotomy	Robotic-assisted	1
Atallah et al[31], 2015		1	da Vinci Si	GelPOINT + Lonestar	Dorsal lithotomy	Robotic-assisted	2	1st robotic ISR + TaTME
Huscher et al[32], 2015	January 2014 April 2014	7	da Vinci Si	GelPOINT path		Robotic-assisted	1
Kuo et al[33], 2017	July 2015 March 2016	15	da Vinci Si	GelPOINT path	Lithotomy 15º trendelenburg	Totally robotic	1	Robotic SSPO
Hu et al[34], 2020	January 2016 November 2016	20	daVinci Xi	GelPOINT path	Lithotomy	Robotic-assisted	2
Monsellato et al[35], 2019	May 2017 October 2017	3	da Vinci Si	GelPOINT path	Dorsal lithotomy	Robotic-assisted	1 (2)
							2 (1)
Tan et al[36], 2020	September 2019	1				Robotic-assisted	2	Laparoscopic SSPO
Suhardja et al[37], 2020		1	da Vinci Xi	Lone Star +	Lloyd-Davies	Totally robotic	1
				GelPOINT path
Ye et al[38], 2021	May 2017 January 2020	13	da Vinci Si	STARport path	Lithotomy trendelenburg	Totally robotic (9)	1 (9)
						Robotic-assisted (4)	2 (4)

¹Patient included in the study published by Atallah et al[30] in 2015.

Remarked as the first report on robotic Transanal total mesorectal excision. SSPO: Single-site plus one port; TaTME: Transanal total mesorectal excision.

Table 2 Demographic and preoperative data, n (%)

Ref.	n	Male/female	Age (yr)	BMI (kg/m2)	Tumor DAV (cm)	Clinical stage (I/II/III/IV)	Neoadjuvant treatment	Type
Verheijen et al[26], 2014	1	0/1 (100)	48	23.6	8	0/0/1/0	1 (100)	CRT
Gómez Ruiz et al[29], 2015	5	4 (80)/1 (20)	57 ± 13.91	25.8 ± 2.71	5 (4-6)2	1/0/4/0	4 (80)	CRT
Atallah et al[30], 2015	4	3 (75)/1 (25)	44 (26-59)2	29 (21-38)2		1/0/3/0	3 (75)	CRT
Atallah et al[31], 2015	1	1 (100)/0	66	31.6	< 0.43	1/0/0/0	0
Huscher et al[32], 2015	7	3 (42.9)/4 (57.1)	63.2 ± 9.71	29.9 ± 6.11	2 (1–6.5)4	5/2/0/0	0
Kuo et al[33], 2017	15	7 (46.7)/8 (53.3)	60.3 (44–75)4	21.97	3.3 (2.0–5.0)4		11 (73.3)	CRT
Hu et al[34], 2020	20	13 (65)/7 (35)	56.3 ± 14.41	23.9 ± 3.41	5.8 ± 2.61	4/4/10/2	12 (60)	CRT 9 (45)RT 3 (15)
Monsellato et al[35], 2019	3	2 (66.6)/1 (33.3)	61 (55–68)2	26 (25–28)2	4.33 (3-6)2	0/0/3/0	3 (100)	CRT
Tan et al[36], 2020	1	1 (100)/0	71	24.08	3	0/0/1/0	1 (100)	CT
Suhardja et al[37], 2020	1	1 (100)/0	67		6	0/0/1/0	1 (100)	CRT
Ye et al[38], 2021	13	9 (69.2)/4 (30.8)	62 (42- 67)5	22.26 (20.90–24.08)5	4.5 (4- 6)5	1/2/10/0	11 (84.6)	CRT

¹mean ± SD.

²Mean value (range).

³Distance from dentate line.

⁴Median (range).

⁵Median (interquartile range).

BMI: Body mass index; CRT: Chemoradiotherapy; CT: Chemotherapy; DAV: Distance form anal verge; RT: Radiotherapy.

Table 3 Intraoperative and postoperative outcomes, n (%)

Ref.	OT, min	TransanalOT, min	Abdominal OT, min	Blood loss, mL	Splenic flexure mobilization	Transanal specimen extraction	Defunctioning stoma	Anastomosis method (H/S/E)1	Anastomosis height (n)	Intraoperative complications	Conversion	Postoperative complications	Length of stay, d	Mortality
Verheijen et al[26], 2014	205	65		50	Yes	1 (100)	1 (100)	100%/0%/0%	Colorectal	No	No	No	3	0%
Gómez Ruiz et al[29], 2015	398 ± 882	123 ± 502	112 ± 272	90 ± 502	Yes	5 (100)	5 (100)	40%/60%/0%	Coloanal (2); Colorectal (3)	No	No	1 (20)	6 ± 12	0%
Atallah et al[30], 2015	376 (140-409)3			200 (50-300)3	Yes		3 (75)	75%/0%/25%	Coloanal (3)	No	No	3 (75)	4.3 (4-5)3	0%
Atallah et al[31], 2015	316			75			1 (100)	100%/0%/0%	Coloanal (1)	No	No	No		0%
Huscher et al[32], 2015	165.7 ± 54.42	55.5 ± 12.42			Yes	7 (100)	7 (100)	0%/100%/0%	Coloanal (7)	No	No	1 (14.29)	4.8 ± 0.62	0%
Kuo et al[33], 20167	473 (335–569)4			33 (30–50)4		15 (100)	5 (33.3)	100%/0%/0%	Coloanal (15)	1 (6.7)	2 (13.3) to laparoscopic	2 (13.3)	12.2 ± 1.52	0%
Hu et al[34], 2020	172.3 ± 24.22			82.0 ± 107.12	Yes (25)		L-colostomy 6 (30); L-ileostomy 8 (40)	10%/80%/10%	Coloanal (2); Colorectal (16)	1 (5)	No	7 (35)	8.8 ± 4.22	0%
Monsellato et al[35], 2019	530 (440–600)3			Inconsistent	Yes	3 (100)	3 (100)	100%/0%/0%	Coloanal (3)	No	No	No	10.6 (7-15)3	0%
Tan et al[36], 2020	132			20						No	No	No	6	0%
Suhardja et al[37], 2020	210	50	160			No	1 (100)	0%/100%/0%	Colorectal (1)	No	No	No	5	0%
Ye et al[38], 2021	240 (195–270)5	95 (74–100)5		60 (50–100)5	Yes	13 (100)	12 (92.3)	61.5%/38.5%/0%	Coloanal (9); Colorectal (4)	No	No	3 (23.1)	7 (6–10)5	0%

¹H/S/E: Hand-sewn/stapled/end-enterostomy.

²mean ± SD.

³Mean value (range).

⁴Median (range).

⁵Median (interquartile range).

OT: Operative time.

Table 4 Detail of postoperative complications

Ref.
Gómez Ruiz et al[29], 2015	Grade B anastomotic leak diagnosed in the outpatient clinic on postoperative day 14
Atallah et al[30], 2015	Sub-segmental pulmonary embolism
	Dehydration related to high output from his diverting ileostomy that required readmission 3 wk postoperatively
	Wound hematoma requiring drainage 2 wk postoperatively
Huscher et al[32], 2015	Rectal bleeding requiring the transfusion of blood units without reoperation
Kuo et al[33], 2017	Laparoscopic adhesiolysis for postoperative intestinal obstruction
	Superficial wound infection
Hu et al[34], 2020	Postoperative Ileus with Conservative treatment
	Pelvic abscess treated with antibiotics
	Acute urinary retention that required reinsertion of Foley catheter
	Perineal wound bleeding that needed hemostasis
	Duodenal ulcer bleeding with conservative treatment
	Fever with unknown origin with conservative treatment
	Acute appendicitis managed with antibiotics
Ye et al[38], 2021	Anastomotic leakage grade B on postoperative day 3History of duodenal ulcer with duodenal hemorrhage on postoperative day 7 solved with conservative treatment
	Postoperative ileus treated with gastrointestinal decompression and parenteral nutrition

Table 5 Pathologic, oncological, and functional outcomes

Ref.	Tumor size, cm	Quality TME (I/II/III), %	CRM +	Distal margin +	Harvested nodes	DAV, cm	CRM, cm	Follow-up, mo	Local recurrence	Distant progression, m	Functional (urinary/sexual)
Verheijen et al[26], 2014		100/0/0	No	No		2
Gómez Ruiz et al[29], 2015		100/0/0	No	No	14 ± 91	1.8 (1-2.5)2		3 (3)2	No
Atallah et al[30], 2015	2.7 (1.5-3.5)2	25/75/0	No	No	27 (15-39)3	3.3 (1-5)3		8 (6-12)3	No	No
Atallah et al[31], 2015	3	100/0/0	No	No	33	0.4
Huscher et al[32], 2015		85.7/14.3/0	No	No	14 ± 31	2.7 ± 21	3.2 ± 1.81	2.5 (2–3.5)2
Kuo et al[33], 2017		100/0/0	No	No	12 (8-18)3	1.4 (0.4–3.5)3	0.7 (0.2-2.6)3
Hu et al[34], 2020	3.3 ± 1.51	90/10/0	3 (15)	No	18.7 ± 6.31	2.9 ± 1.31	0.88 ± 0.781		1 (5) 18 m	1 (5) 7
Monsellato et al[35], 2019		100/0/0	No	No				12 (12)	No	No
Tan et al[36], 2020								7	No	No
Suhardja et al[37], 2020		100/0/0	No	No	24			12	No	No	No
Ye et al[38], 2021	3 (2–4)4	61.5/38.5/0	No	No	15 (13-16)4	2 (1.5–2.5)4		15 (11–18)4	No	No

¹mean ± SD.

²Mean value (range).

³Median (range).

⁴Median (interquartile range).

CRM: Circumferential resection margin; DAV: Distance from anal verge; TME: Total mesorectal excision.