Skip to main content
SpringerLink
Log in

Review and update: robotic transanal surgery (RTAS)

  • Review Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

As the field of surgery advances, new approaches have allowed surgeons additional flexibility to perform further interventions with minimal or no external incisions. For many years, single site access (SSA) has been used for transanal procedures, and platforms allowing modified endoscopic approaches have been available. These platforms have limitations related to access, visualization, dexterity, camera control, and instrumentation. Recently, surgical robotics companies have developed and introduced new technologies and platforms, which may help address some of these limitations. Comprehensive internet, open access, and medical and industry conference reviews of robotic surgery platforms and technology available for use in SSA surgery were conducted and 30 articles were found using keywords “robotic surgery, transanal, single site, robotic transanal surgery”. A PubMed, Medline, Journals @OVID and open access search for data related to these platforms and technologies was also performed yielding 11 articles. Abstracts were reviewed for those written in the English language, leaving 40 articles which were then filtered for those pertaining to robotic surgery, transanal. 58 abstracts were found, duplicates were eliminated, and the remaining 35 articles were read in their entirety by two reviewers. Several new and existing platforms are identified for use in SSA surgery for transanal surgery as well as abdominal and transoral surgery. These are reviewed, including brand, features, approved and suggested uses, and potential limitations. New robotic technologies serve to enhance the ability of surgeons to perform SSA surgery. This next generation of robotic surgery technology overcomes some of the limitations of preceding endoscopic SSA surgery technology and will enhance the advancement of robotic transanal surgery, but outcomes and performance data are still limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

RTAS:

Robotic transanal surgery

SSA:

Single site access

NOTES:

Natural orifice transluminal endoscopic surgery

TEMS:

Transanal endoscopic microsurgery

TAMIS:

Transanal minimally invasive surgery

TME:

Total mesorectal excision

TaTME:

Transanal total mesorectal excision

DVSSP:

da Vinci single-site© surgical platform

RATS-TME:

Robotic-assisted transanal surgery for total mesorectal excision

References

  1. Buess G, Hutterer F, Theiss R, Boebel M, Isselhard W, Pichlmaier H (1984) Das System fur die transanale endoskopische Rektumoperation. Chir 55:677–680

    CAS  Google Scholar 

  2. Nau P, Sylla P (2012) Surgical innovation: from laparoscopy to natural orifice transluminal endoscopic surgery. Gastrointest Interv 1:25–29

    Article  Google Scholar 

  3. Abbott DJ, Becke C, Rothstein R, Peine WJ (2007) Design of an endoluminal NOTES robotic system. In: IEEE international conference on intelligent robots and systems, pp 410–416

  4. Phee SJ, Low SC, Sun ZL et al (2008) Robotic System for no-scar gastrointestinal surgery. Int J Med Robot Comput Assist Surg 1(4):15–22

    Article  Google Scholar 

  5. Simaan N, Xu K, Wei W, Kapoor A, Kazanzides P, Taylor R, Flint P (2009) Design and integration of a telerobotic system for minimally invasive surgery of the throat. Int J Robot Res 28(9):1134–1153

    Article  Google Scholar 

  6. Piccigallo M, Scarfogliero U, Quaglia C, Petroni G, Valdastri P, Menciassi A, Dario P (2010) Design of a novel bimanual robotic system for single-port laparoscopy. IEEE/ASME Trans Mechatron 15(6):871–878

    Google Scholar 

  7. Kobayashi Y et al (2015) Development of a robotic system with six-degrees of-freedom robotic tool manipulators for single-port surgery. Int J Med Robot 11:235–246

    Article  PubMed  Google Scholar 

  8. Shang J, Noonan D, Payne C, Clark J, Sodergren MH, Darzi A, Yang GZ (2011) An articulated universal joint based flexible access robot for minimally invasive surgery, robotics and automation (ICRA). In: 2011 IEEE international conference

  9. Shang J, Payne C, Clark J et al (2012) Design of a multitasking robotic platform with flexible arms and articulated head for minimally invasive surgery. In: 2012 IEEE/RSJ international conference of intelligent robotics and systems. Vilamoura, Algarve, Portugal

  10. Shang J, Leibrandt K, Giataganas P et al (2017) A single-port robotic system for transanal micro-surgery—design and validation. IEEE Robot Autom Lett 2:1510–1517

    Article  Google Scholar 

  11. Vitiello V et al (2013) Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 6:111–126

    Article  PubMed  Google Scholar 

  12. Kaouk JH et al (2014) A Novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 66:1033–1043

    Article  PubMed  Google Scholar 

  13. Marks J, Ng S, Mak T (2017) Robotic transanal surgery with utilization of a next-generation single-pot system: a cadaveric feasibility study. Tech Coloproctol 21(7):541–545

    Article  CAS  PubMed  Google Scholar 

  14. Lang S, Mattheis S, Hasskamp P, Lawson G, Güldner C, Mandapathil M, Schuler P, Hoffmann T, Scheithauer M, Remacle M (2016) A European multicenter study evaluating the flex robotic system in transoral robotic surgery. Laryngoscope 127(2):391–395

    Article  PubMed  Google Scholar 

  15. Schuler PJ, Duvvuri U, Friedrich DT, Rotter N, Scheithauer MO, Hoffmann TK (2014) First use of a computer-assisted operator-controlled flexible endoscope for transoral surgery. Laryngoscope. 125(3):645–648

    Article  PubMed  Google Scholar 

  16. Remacle M, Prasad VMN, Lawson G, Plisson L, Bachy V, Van der Vorst S (2015) Transoral robotic surgery (TORS) with the Medrobotics Flex® System: first surgical application on humans. Eur Arch Otorhinolaryngol 272(6):1451–1455

    Article  CAS  PubMed  Google Scholar 

  17. 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(10):809–814

    Article  CAS  PubMed  Google Scholar 

  18. Haber GP et al (2012) SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application. Eur Urol 61:415–422

    Article  PubMed  Google Scholar 

  19. Roh SG, Lee Y, Lee J (2015) Development of the SAIT single-port surgical access robot slave arm based on RCM mechanism. In: Engineering in medicine and biology society (EMBC), 2015 37th annual international conference of the IEEE. IEEE, 2015

  20. Cha E, Unal E, Marks JH (2017) A role of robotic surgery in colorectal cancer therapy—past, present and future. JSM Gastroenterol Hepatol 5(3):1085

    Google Scholar 

  21. Atallah S, Martin-Perez B, Parra-Davila E et al (2015) Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution. Tech Coloproctol 19(7):401–410

    Article  CAS  PubMed  Google Scholar 

  22. Atallah S, Parra-Davila E, DeBeche-Adams T, Albert M, Larach S (2012) Excision of a rectal neoplasm using robotic transanal surgery (RTS): a description of the technique. Tech Coloproctol 16:389–392

    Article  CAS  PubMed  Google Scholar 

  23. Hompes R (2015) Robotics and transanal minimal invasive surgery (TAMIS): the “sweet spot” for robotics in colorectal surgery? Tech Coloproctol 19(7):377–378

    Article  CAS  PubMed  Google Scholar 

  24. Atallah SB, Albert MR, deBeche-Adams TH, Larach SW (2011) Robotic TransAnal minimally invasive surgery in a cadaveric model. Tech Coloproctol 15(4):461–464

    Article  CAS  PubMed  Google Scholar 

  25. Heidary B, Phang TP, Raval MJ, Brown CJ (2014) Transanal endoscopic microsurgery: a review. Can J Surg 57(2):127–138

    Article  PubMed  PubMed Central  Google Scholar 

  26. Morelli L, Guadagni S, Di Franco G, Palmeri M, Di Candio G, Mosca F (2016) Da Vinci single site© surgical platform in clinical practice: a systematic review. Int J Med Robot Comput Assist Surg 12:724–734

    Article  Google Scholar 

  27. Shang J et al (2017) A single-port robotic system for transanal microsurgery—design and validation. IEEE Robot Autom Lett 99:1

    Google Scholar 

  28. Atallah S, Nassif G, Polavarapu H et al (2013) Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration. Tech Coloproctol 17:441–447

    Article  CAS  PubMed  Google Scholar 

  29. 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(5):578–581

    Article  CAS  PubMed  Google Scholar 

  30. 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(2):249–254

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Illinois College of Medicine at Peoria, Office of Graduate Medical Education, Peoria, IL, USA

    Melissa G. Medina, Steven S. Tsoraides & Anthony M. Dwyer

  2. Department of General Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA

    Melissa G. Medina & Steven S. Tsoraides

Authors
  1. Melissa G. Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven S. Tsoraides
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony M. Dwyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony M. Dwyer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Medina, M.G., Tsoraides, S.S. & Dwyer, A.M. Review and update: robotic transanal surgery (RTAS). Updates Surg 70, 369–374 (2018). https://doi.org/10.1007/s13304-018-0580-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-018-0580-y

Keywords

Search

Navigation