Advertisement

Updates in Surgery

, Volume 71, Issue 1, pp 29–37 | Cite as

Transanal total mesorectal excision (TaTME): current status and future perspectives

  • Andrea VignaliEmail author
  • Ugo Elmore
  • Marco Milone
  • Riccardo Rosati
Review Article

Abstract

Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through an enhanced visualization of the dissection plane. This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. The indications for TaTME are currently expanding, despite not being yet standardized, and structured training programs are ongoing to help overcome the steep learning curve related to the technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates when compared with conventional open or laparoscopic TME. Favorable short-term oncologic results have been reported: in particular, TaTME is associated with mesorectal specimen of a better quality and a longer distal resection margin that is established at the beginning of the procedure under direct view. Robotics, when available, will probably overcome the steep learning curve related to the complexity of TaTME. Long-term follow-up and ongoing RCT trials data are awaited regarding functional results, local recurrence and survival, and to facilitate the comparison with standard laparoscopic or robotic rectal resections. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, its indications, short- and long-term results and future direction in the application of TaTME.

Keywords

Rectal cancer Total mesorectal excision (TME) Transanal total mesorectal excision TaTME Robotics 

Notes

Acknowledgements

A special thanks goes to Francesca Aleotti MD for her precious help in linguistic reviewing and redrafting the manuscript.

Compliance with ethical standards

Conflict of interest

All authors mentioned in this study do not have any competing interest. This specific report does not endorse any specific Company.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

The informed consent does not apply since this is a meta-analysis study.

References

  1. 1.
    Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774.  https://doi.org/10.1016/S1470-2045(14)70205-0 CrossRefGoogle Scholar
  2. 2.
    Garlipp B, Ptok H, Schmidt U, Garlipp B, Stübs P, Scheidbach H, Meyer F, Gastinger I, Lippert H (2012) Factors influencing the quality of total mesorectal excision. Br J Surg 99:714–720.  https://doi.org/10.1002/bjs.8692 CrossRefPubMedGoogle Scholar
  3. 3.
    Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Miyata S, Yamaguchi T (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146:483–489.  https://doi.org/10.1016/j.surg.2009.03.030 CrossRefPubMedGoogle Scholar
  4. 4.
    Atallah S, Albert M, Larach S (2010) Transanal minimally invasivesurgery: a giant leap forward. Surg Endosc 24:2200–2205.  https://doi.org/10.1007/s00464-010-0927-z CrossRefGoogle Scholar
  5. 5.
    Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210.  https://doi.org/10.1007/s00464-010-0965-6 CrossRefPubMedGoogle Scholar
  6. 6.
    Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61.  https://doi.org/10.1007/s10151-014-1254-5 CrossRefPubMedGoogle Scholar
  7. 7.
    Dumont F, Goéré D, Honoré C, Elias D (2012) Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum 55:996–1001.  https://doi.org/10.1097/DCR.0b013e318260d3a0 CrossRefPubMedGoogle Scholar
  8. 8.
    Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56:408–415.  https://doi.org/10.1097/DCR.0b013e3182756fa0 CrossRefPubMedGoogle Scholar
  9. 9.
    Lee GC, Sylla P (2015) Shifting paradigms in minimally invasive surgery: applications of transanal natural orifice transluminal endoscopic surgery in colorectal surgery. Clin Colon Rectal Surg 28:181–193.  https://doi.org/10.1055/s-0035-1555009 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    De Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, Sylla P, Martínez-Palli G (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)–short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172.  https://doi.org/10.1007/s00464-013-2872-0 CrossRefGoogle Scholar
  11. 11.
    Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221:415–423.  https://doi.org/10.1016/j.jamcollsurg.2015.03.046 CrossRefPubMedGoogle Scholar
  12. 12.
    Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer: short term outcomes in comparison with laparoscopic surgery. Ann Surg 261:221–227.  https://doi.org/10.1097/SLA.0000000000000865 CrossRefPubMedGoogle Scholar
  13. 13.
    Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 18:473–480.  https://doi.org/10.1007/s10151-013-1095-7 CrossRefPubMedGoogle Scholar
  14. 14.
    Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy AM, Rattner DW (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 27:3396–3405.  https://doi.org/10.1007/s00464-013-2922-7 CrossRefPubMedGoogle Scholar
  15. 15.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117.  https://doi.org/10.1097/SLA.0000000000001948 CrossRefPubMedGoogle Scholar
  16. 16.
    Penna M, Hompes R, Mackenzie H, Carter F, Francis NK (2016) First international training and assessment consensus workshop on transanal total mesorectal excision (TaTME). Tech Coloproctol 20:343–352.  https://doi.org/10.1007/s10151-016-1454-2 CrossRefPubMedGoogle Scholar
  17. 17.
    Motson RW, Whiteford MH, Hompes R, Albert M, Miles WF, Expert Group (2016) Current status of trans-anal total mesorectal excision (TaTME) following the Second International Consensus Conference. Colorectal Dis 18:13–18.  https://doi.org/10.1111/codi.13131 (PMID:26400670) CrossRefPubMedGoogle Scholar
  18. 18.
    Adamina M, Buchs NC, Penna M, Hompes R, on behalf of the St.Gallen Colorectal Consensus Expert Group (2018) St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 32:1091–1110.  https://doi.org/10.1007/s00464-017-5990-2 CrossRefPubMedGoogle Scholar
  19. 19.
    Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C, Tuynman JB, Lacy AM, Hanna GB, Bonjer HJ (2016) COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 30:3210–3215.  https://doi.org/10.1007/s00464-015-4615-x CrossRefGoogle Scholar
  20. 20.
    Francis N, Penna M, Mackenzie H, Carter F, Hompes R, International TaTME Educational Collaborative Group (2017) Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 31:2711–2719.  https://doi.org/10.1007/s00464-017-5562-5 CrossRefGoogle Scholar
  21. 21.
    Telem DA, Han KS, Kim MC, Ajari I, Sohn DK, Woods K, Kapur V, Sbeih MA, Perretta S, Rattner DW, Sylla P (2013) Transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) with total mesorectal excision in a large human cadaver series. Surg Endosc 27:74–80.  https://doi.org/10.1007/s00464-012-2409-y CrossRefPubMedGoogle Scholar
  22. 22.
    Buchs NC, Wynn G, Austin R, Penna M, Findlay JM, Bloemendaal AL, Mortensen NJ, Cunningham C, Jones OM, Guy RJ, Hompes R (2016) A two-centre experience of transanal total mesorectal excision. Colorectal Dis 18:1154–1161.  https://doi.org/10.1111/codi.13394 CrossRefPubMedGoogle Scholar
  23. 23.
    Koedam TWA, Veltcamp Helbach M, van de Ven PM, Kruyt PM, van Heek NT, Bonjer HJ, Tuynman JB, Sietses C (2018) Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve. Tech Coloproctol 22:279–287.  https://doi.org/10.1007/s10151-018-1771-8 CrossRefPubMedGoogle Scholar
  24. 24.
    Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP (2016) A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 18:19–36.  https://doi.org/10.1111/codi.13151 CrossRefPubMedGoogle Scholar
  25. 25.
    Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H, Wang Z (2016) Transanal total mesorectal excision (TaTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380.  https://doi.org/10.1186/s12885-016-2428-5 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Deijen CL, Tsai A, Koedam TW, Veltcamp Helbach M, Sietses C, Lacy AM, Bonjer HJ, Tuynman JB (2016) Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol 20:811–824.  https://doi.org/10.1007/s10151-016-1545-0 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Atallah S, Mabardy A, Volpato AP, Chin T, Sneider J, Monson JRT (2017) Surgery beyond the visible light spectrum: theoretical and applied methods for localization of the male urethra during transanal total mesorectal excision. Tech Coloproctol 21:413–424.  https://doi.org/10.1007/s10151-017-1641-9 CrossRefPubMedGoogle Scholar
  28. 28.
    Bjørn MX, Perdawood SK (2015) Transanal total mesorectal excision—a systematic review. Dan Med J 62:A5105PubMedGoogle Scholar
  29. 29.
    Perdawood SK, Thinggaard BS, Bjorn MX (2017) Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc.  https://doi.org/10.1007/s00464-017-5926-x (Epub ahead of print) CrossRefPubMedGoogle Scholar
  30. 30.
    Kneist W, Rink AD, Kauff DW, Konerding MA, Lang H (2015) Topography of the extrinsic internal anal sphincter nerve supply during laparoscopic-assisted TAMIS TME: five key zones of risk from the surgeons’ view. Int J Colorectal Dis 30:71–78.  https://doi.org/10.1007/s00384-014-2026-4 CrossRefPubMedGoogle Scholar
  31. 31.
    Franchini Melani AG, Diana M, Marescaux J (2016) The quest for precision in transanal total mesorectal excision. Tech Coloproctol 20:11–18.  https://doi.org/10.1007/s10151-015-1405-332 CrossRefPubMedGoogle Scholar
  32. 32.
    Atallah S, Martin-Perez B, Larach S (2015) Image-guided real-time navigation for transanal total mesorectal excision: a pilot study. Tech Coloproctol 19:679–684.  https://doi.org/10.1007/s10151-015-1329-y CrossRefPubMedGoogle Scholar
  33. 33.
    Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2016) Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc 30:464–470.  https://doi.org/10.1007/s00464-015-4221-y CrossRefPubMedGoogle Scholar
  34. 34.
    Rasulov AO, Mamedli ZZ, Gordeyev SS, Kozlov NA, Dzhumabaev HE (2016) Short-term outcomes after transanal and laparoscopic total mesorectal excision for rectal cancer. Tech Coloproctol 20:227–234.  https://doi.org/10.1007/s10151-015-1421-3 CrossRefPubMedGoogle Scholar
  35. 35.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218.  https://doi.org/10.1016/s1470-2045(13)70016-0 CrossRefPubMedGoogle Scholar
  36. 36.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726.  https://doi.org/10.1016/S0140-6736(05)66545-2 CrossRefPubMedGoogle Scholar
  37. 37.
    Al Perdawood S, Khefagie G (2016) Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal Dis 18:51–58.  https://doi.org/10.1111/codi.13225 CrossRefGoogle Scholar
  38. 38.
    Noh GT, Ann YS, Cheong C, Han J, Cho MS, Hur H, Min BS, Lee KY, Kim NK (2016) Impact of anastomotic leakage on long-term oncologic outcome and its related factors in rectal cancer. Medicine 95:e4367.  https://doi.org/10.1097/MD.0000000000004367 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Neshakken A, Nygaard K, Lunde OC (2000) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404.  https://doi.org/10.1046/j.1365-2168.2001.01719 CrossRefGoogle Scholar
  40. 40.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP (2018) International TaTME registry collaborative incidence and risk factors for anastomotic failure in 1594 patients treated by transanal Total Mesorectal Excision: results from the International TaTME registry. Ann Surg.  https://doi.org/10.1097/sla.0000000000002653 (Epub ahead of print) CrossRefPubMedGoogle Scholar
  41. 41.
    Holmer C, Kreis ME (2018) Systematic review of robotic low anterior resection for rectal cancer. Surg Endosc 32:569–581.  https://doi.org/10.1007/s00464-017-5978-y CrossRefPubMedGoogle Scholar
  42. 42.
    Hua L, Wang C, Yao K, Zhang J, Chen J, Ma W (2014) Is the incidence of postoperative anastomotic leakage different between laparoscopic and open total mesorectal excision in patients with rectal cancer? A meta-analysis based on randomized controlled trials and controlled clinical trials. J Cancer Res Ther 10(Suppl):272–275.  https://doi.org/10.4103/0973-1482.151491 CrossRefPubMedGoogle Scholar
  43. 43.
    Velthuis S, Veltcamp Helbach M, Tuynman JB, Le TN, Bonjer HJ, Sietses C (2015) Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc 29:3319–3323.  https://doi.org/10.1007/s00464-015-4089-x CrossRefPubMedGoogle Scholar
  44. 44.
    Koedam TW, van Ramshorst GH, Deijen CL, Elfrink AK, Meijerink WJ, Bonjer HJ, Sietses C, Tuynman JB (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 21:25–33.  https://doi.org/10.1007/s10151-016-1570-z CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E (2016) Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 30:4924–4933.  https://doi.org/10.1007/s00464-016-4833-x CrossRefPubMedGoogle Scholar
  46. 46.
    Rouanet P, Saint-Aubert B, Lemanski C, Senesse P, Gourgou S, Quenet F, Ycholu M, Kramar A, Dubois J (2002) Restorative and nonrestorative surgery for low rectal cancer after high-dose radiation: long-term oncologic and functional results. Dis Colon Rectum 45:305–313CrossRefPubMedGoogle Scholar
  47. 47.
    Veltcamp Helbach M, Koedam TWA, Knol JJ, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2018) Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc.  https://doi.org/10.1007/s00464-018-6276-z (Epub ahead of print) CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89:1551–1556.  https://doi.org/10.1046/j.1365-2168.2002.02275.x CrossRefPubMedGoogle Scholar
  49. 49.
    Tuech J, Karoui M, Lelong B, Paschold M, Kauff DW, Rink AD, Lang H (2015) A step towards NOTES total mesorectal excision for rectal cancer. Ann Surg 261:228–233.  https://doi.org/10.1007/s10151-015-1390-6 CrossRefPubMedGoogle Scholar
  50. 50.
    Kneist W, Wachter N, Paschold M, Kauff D, Rink A, Lang H (2016) Midterm functional results of TaTME with neuromapping for low rectal cancer. Tech Coloproctol 20:41–49.  https://doi.org/10.1007/s10151-015-1390-6 CrossRefPubMedGoogle Scholar
  51. 51.
    de Lacy FB, van Laarhoven JJEM, Pena R, Arroyave MC, Bravo R, Cuatrecasas M, Lacy AM (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 32:2442–2447.  https://doi.org/10.1007/s00464-017-5944-8 CrossRefPubMedGoogle Scholar
  52. 52.
    Hu D, Jin P, Hu L, Liu W, Zhang W, Guo T, Yang X (2018) The application of transanal total mesorectal excision for patients with middle and low rectal cancer: a systematic review and meta-analysis. Medicine 97:e11410.  https://doi.org/10.1097/MD.0000000000011410 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Veltcamp Helbach M, Koedam TWA, Knol JJ, Diederik A, Spaargaren GJ, Bonjer HJ, Tuynman JB, Sietses C (2018) Residual mesorectum on postoperative magnetic resonance imaging following transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LapTME) in rectal cancer. Surg Endosc.  https://doi.org/10.1007/s00464-018-6279-9 (Epub ahead of print) CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Lelong B, Meillat H, Zemmour C, Poizat F, Ewald J, Mege D, Lelong JC, Delpero JR, de Chaisemartin C (2017) Short- and mid-term outcomes after endoscopic transanal or laparoscopic transabdominal total mesorectal excision for low rectal cancer: a single institutional case-control study. J Am Coll Surg 224:917–925CrossRefPubMedGoogle Scholar
  55. 55.
    Burke JP, Martin-Perez B, Khan A, Nassif G, de Beche-Adams T, Larach SW, Albert MR, Atallah S (2016) Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis 18:570–577.  https://doi.org/10.1111/codi.13263 CrossRefPubMedGoogle Scholar
  56. 56.
    Marks J, Montenegro G, Salem J, Shields M, Marks G (2016) Transanal TATA/TME: a case-matched study of TaTME versus laparoscopic TME surgery for rectal cancer. Tech Coloproctol 20:467–473.  https://doi.org/10.1007/s10151-016-1482-y CrossRefPubMedGoogle Scholar
  57. 57.
    Muratore A, Mellano A, Marsanic P, De Simone M (2015) Transanal total mesorectal excision (TaTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 41:478–483.  https://doi.org/10.1016/j.ejso.2015.01.009 CrossRefPubMedGoogle Scholar
  58. 58.
    Yao HW, Wu GC, Yang YC, Jin L, Zhang ZP, Chen N, Zhang ZT (2017) Laparoscopic-assisted transanal total mesorectal excision for middle-low rectal carcinoma: a clinical study of 19 cases. Anticancer Res 37:4599–4604PubMedGoogle Scholar
  59. 59.
    Pellino G, Warusavitarne J (2017) Medium-term adoption trends for laparoscopic, robotic and transanal total mesorectal excision (TaTME) techniques. Tech Coloproctol 21:911–913.  https://doi.org/10.1007/s10151-017-1719-4 CrossRefPubMedGoogle Scholar
  60. 60.
    Gu JC, Tsang CB, Koh DC (2017) The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery. Robot Surg Res Rev 4:77.  https://doi.org/10.2147/RSRR.S119317 CrossRefGoogle Scholar
  61. 61.
    Hompes R, Rauh SM, Ris F, Tuynman JB, Mortensen NJ (2014) Robotic transanal minimally invasive surgery for local excision of rectal neoplasms. Br J Surg 101:578–581.  https://doi.org/10.1002/bjs.9454 CrossRefPubMedGoogle Scholar
  62. 62.
    Atallah S, Martin-Perez B, Pinan J, Quinteros F, Schoonyoung H, Albert M, Larach S (2014) Robotic transanal total mesorectal excision: a pilot study. Tech Coloproctol 18:1047–1053.  https://doi.org/10.1007/s10151-014-1181-5 CrossRefPubMedGoogle Scholar
  63. 63.
    Gómez Ruiz M, Parra IM, Palazuelos CM, Martín JA, Fernández CC, Diego JC, Fleitas MG (2015) Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum 58:145–153.  https://doi.org/10.1097/DCR.0000000000000265 CrossRefPubMedGoogle Scholar
  64. 64.
    Huscher CG, Bretagnol F, Ponzano C (2015) Robotic-assisted transanal total mesorectal excision: the key against the Achilles’ heel of rectal cancer? Ann Surg 261:e120–e121.  https://doi.org/10.1097/SLA.0000000000001089 CrossRefPubMedGoogle Scholar
  65. 65.
    Kuo LJ, Ngu JC, Tong YS, Chen CC (2017) Combined robotic transanal total mesorectal excision (R-TaTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery-initial experience with a new operation approach. Int J Colorectal Dis 32:249–254.  https://doi.org/10.1007/s00384-016-2686-3 CrossRefPubMedGoogle Scholar
  66. 66.
    Verheijen PM, Consten EC, Broeders IA (2014) Robotic transanal total mesorectal excision for rectal cancer: experience with a first case. Int J Med Robot 10:423–426.  https://doi.org/10.1002/rcs.1594 CrossRefPubMedGoogle Scholar
  67. 67.
    Atallah S (2017) Assessment of a flexible robotic system for endoluminal applications and transanal total mesorectal excision (TaTME): could this be the solution we have been searching for? Tech Coloproctol 21:809–814.  https://doi.org/10.1007/s10151-017-1697-6 CrossRefPubMedGoogle Scholar
  68. 68.
    Emile SH, de Lacy FB, Keller DS, Martin-Perez B, Alrawi S, Lacy AM, Chand M (2018) Evolution of transanal total mesorectal excision for rectal cancer: from top to bottom. World J Gastrointest Surg 10:28–39.  https://doi.org/10.4240/wjgs.v10.i3.28 CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Mizrahi I, Sands DR (2017) Transanal total mesorectal excision for rectal cancer: a review. Ann Laparosc Endosc Surg 2:144–152.  https://doi.org/10.21037/ales.2017.08.07 CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.Department of SurgerySan Raffaele Hospital and San Raffaele Vita-Salute UniversityMilanItaly
  2. 2.Department of Surgical SpecialtiesNephrology University “Federico II” of NaplesNaplesItaly

Personalised recommendations