From TATA to single port robotic (SPr) taTME: approaches to distal rectal cancer

Abstract

The surgical management of rectal cancers located in the distal rectum presents a unique challenge for surgeons as it is anatomically unfavorable and technically difficult to access. Over the course of the 20th century, novel techniques contributed to the improvement of rectal cancer management and led to improved quality of life for patients following surgical resection. In this article, we explore the background of rectal surgery techniques, which have progressed from abdominal perineal resection to transanal abdominal transanal proctosigmoidectomy, transanal total mesorectal excision (taTME), and ultimately minimally invasive transanal sphincter preserving techniques utilizing single port robotic technology (SPr taTME). In the first clinical experience with the DaVinci SP robot in the United States, we are finding many advantages of this new platform in transanal surgery. The SP offers superior image quality with 3D view, wristed instruments facilitating ergonomics, and superior surgical precision.

Keywords

Transanal abdominal transanal / transanal minimally invasive surgery / da Vinci single-port robot / transanal / rectal cancer

References

[1] Miles WE.A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908)..CA Cancer J Clin1971;21:361-4

[2] Olson RM,Malcolm AW,Wilson RE.Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum..Cancer1980;45:2969-74

[3] Mohiuddin M.High dose preoperative radiation and sphincter preservation in the treatment of rectal cancer..Int J Radiat Oncol Biol Phys1987;13:839-42

[4] Heald RJ.Recurrence and survival after total mesorectal excision for rectal cancer..Lancet1986;1:1479-82

[5] Mohiuddin M,Turalba C,Marks G.A selective sandwich technique of adjuvant radiotherapy in the treatment of rectal cancer: a preliminary experience..Dis Colon Rectum1979;22:1-4

[6] Marks G,Marks J.Nyhus L,Fischer J.Transanal-abdominal transanal radical proctosigmoidectomy with coloanal anastomosis for distal rectal cancer..Mastery of Surgery1996;3rd ed.Little, Brown and Company, Boston, MA

[7] Marks GJ,Mohiuddin M.Radical sphincter preservation surgery with coloanal anastomosis following high-dose external irradiation for the very low lying rectal cancer..Recent Results Cancer Res1998;146:161-74

[8] Kosinski LA,Marks GJ.Cataldo PA.Full-thickness local excision..Transanal endoscopic microsurgery.2009;Verlag New YorkSpringer109-15

[9] Litynski GS.Profiles in laparoscopy: mouret, dubois, and perissat: the laparoscopic breakthrough in Europe (1987-1988)..JSLS1999;3:163-7 PMCID:PMC3015318

[10] Perissat J.Laparoscopic cholecystectomy: the European experience..Am J Surg1993;165:444-9

[11] Atallah S,Larach S.Transanal minimally invasive surgery: a giant leap forward..Surg Endosc2010;24:2200-5

[12] Lacy AM,Delgado S,Rattner DW.Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study..Surg Endosc2013;27:339-46

[13] Leroy J,Melani A,Marescaux J.No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery..JAMA Surg2013;148:226-30

[14] Marks JH,Krishnan B,Montenegro GA.True NOTES TME resection with splenic flexure release, high ligation of IMA, and side-to-end hand-sewn coloanal anastomosis..Surg Endosc2016;30:4626-31

[15] Atallah S,DeBeche-Adams T,Larach S.Excision of a rectal neoplasm using robotic transanal surgery (RTS): a description of the technique..Tech Coloproctol2012;16:389-92

[16] Atallah SB,deBeche-Adams TH.Robotic transanal minimally invasive surgery in a cadaveric model..Tech Coloproctol2011;15:461-4

[17] Marks J,Mak T.Robotic transanal surgery (RTAS) with utilization of a next-generation single-port system: a cadaveric feasibility study..Tech Coloproctol2017;21:541-5

[18] Marks JH,Anderson BK,Schoonyoung HP.Single-port left colectomy: first clinical experience using the SP robot (rSILS)..Tech Coloproctol2020;24:57-63