Transanal Robot-Assisted TME with Single-Port Abdominal Laparoscopy

  • Cristiano Germano Sigismondo Hüscher
  • Cecilia Ponzano
  • Gilda Marzullo


Transanal total mesorectal excision (taTME) is a new approach to perform minimally invasive rectal resection. It has special applications in case of low tumors, narrow pelvis, obese patients, and anteriorly located cancers. It was developed to overcome some drawbacks of laparoscopic TME, basically the difficulty of a low division of the rectum with intracorporeal stapling with a known negative distal margin.

Different platforms have been used to perform this approach, and we herein present the technique and the preliminary results of a small series of robotic transanal TME. More data is necessary to determine whether the robotic approach gives a true advantage compared with other platforms, but the robotic technique certainly gives the advantage of an extremely precise dissection under perfect tridimensional vision in a very narrow space. If this precision will reflect in better oncological and functional outcomes for patients will be the matter for further investigations.


Rectal cancer Transanal total mesorectal excision Robotic TME TaTME 


  1. 1.
    Heald RJ, Ryall RDH. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Heald RJ. The “Holy Plane” of rectal surgery. J R Soc Med. 1988;81:503–8.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Anderson C, Uman G, Pigazzi A, et al. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Oncol. 2008;34:1135–42.CrossRefGoogle Scholar
  4. 4.
    Chand M, Heald RJ. Laparoscopic rectal cancer surgery. Br J Surg. 2011;98:166–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Heald RJ. Rectal cancer patients are often not suitable for laparoscopic surgery. Commentary. Color Dis. 2010;12:31–2.CrossRefGoogle Scholar
  6. 6.
    Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Color Dis. 2008;23:703–7.CrossRefGoogle Scholar
  7. 7.
    Park JS, Choi GS, Kim SH, Kim HR, Kim NK, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013;257:665–71.CrossRefPubMedGoogle Scholar
  8. 8.
    O’Rourke N, Moran BJ, Heald RJ. A laparoscopic triple stapling technique that facilitates anterior resection for rectal cancer. J Laparoendosc Surg. 1994;4(4):261–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Quirke P, Durdey P, Dixon M. Local recurrence of rectal carcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2:996.CrossRefPubMedGoogle Scholar
  10. 10.
    Quirke P, Steele R, Monson J, Grieve R, Khanna S, et al. Effect of plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG C016 randomised clinical trial. Lancet. 2009;373:821–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mark JH, Frenkel JL, D’Andrea AP, Greenleaf CE. Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am. 2011;20:501–20.CrossRefGoogle Scholar
  12. 12.
    Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.CrossRefPubMedGoogle Scholar
  13. 13.
    Gagavan JV, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg. 2004;187:630–4.CrossRefGoogle Scholar
  14. 14.
    Tsai BM, Finne CO, Nordestam JF, Christoforidis D, Madoff RD, Mellgren A. Transanal endoscopic microsurgery of rectal tumors: outcome and recommendations. Dis Colon Rectum. 2010;53(1):16–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Cataldo PA, O’Brien S, Osler T. Transanal endoscopic microsurgery: a prospective evaluation of functional results. Dis Colon Rectum. 2005;48:1366–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Whiteford MH, Denk PM, Swanstrom LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc. 2007;21:1870–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24:1205–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy A, Rattner DW. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc. 2013;27:3396–405.CrossRefPubMedGoogle Scholar
  19. 19.
    Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, Sylla P, Martinez-Palli G. 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. 2013;27:3165–72.CrossRefPubMedGoogle Scholar
  20. 20.
    Heald RJ. A new solution to some old problem: transanal TME. Tech Coloproctol. 2013;17:257–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo PE. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum. 2013;56:408–15.CrossRefPubMedGoogle Scholar
  22. 22.
    Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S. 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. 2014;18(5):473–80.CrossRefPubMedGoogle Scholar
  23. 23.
    Velthius S, van den Boezem PB, van der Peet DL, Cuesta MA, Sietses C. Feasibility study of transanal total mesorectal excision. Br J Surg. 2013;100:828–31.CrossRefGoogle Scholar
  24. 24.
    Zhang H, Zhang YS, Jin XW, Li MZ, Fan JS, Yang ZH. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol. 2013;17:117–23.CrossRefPubMedGoogle Scholar
  25. 25.
    Choi BJ, Lee SC, Kang WK. Single port laparoscopic total mesorectal excision with transanal resection (transabdominal transanal resection) for low rectal cancer: initial experience with 22 cases. Int J Surg. 2013;11:858–63.CrossRefPubMedGoogle Scholar
  26. 26.
    McLemore EC, Coker AM, Devaraj B, Chakedis J, Maawy A, Inui T, Talamini M, Horgan S, Peterson MR, Sylla P, Ramamoorthy S. TAMIS-assisted laparoscopic low anterior resection with total mesorectal excision in a cadaveric series. Surg Endosc. 2013;27:3478–84.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Cahill RA. Single port surgery for rectal cancer—going up or down? Dis Colon Rectum. 2013;56:1199–200.CrossRefPubMedGoogle Scholar
  28. 28.
    Atallah S, Nassif G, Polavarapu H, deBeche-Adams T, Ouyang J, Albert M, Larach S. Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): a description of a novel surgical approach with video demonstration. Tech Coloproctol. 2013;17:441–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Huscher CGS, Bretagnol F, Ponzano C. Robotic-assisted transanal total mesorectal excision the key against the Achilles’ heel of rectal cancer? Ann Surg. 2015;261(5):e120–1.CrossRefPubMedGoogle Scholar
  30. 30.
    Sylla P. Robotically assisted transanal total mesorectal excision: an exciting new trend in rectal cancer surgery. Ann Surg. 2015;261(5):e122.CrossRefPubMedGoogle Scholar
  31. 31.
    Marks G, Mohiuddin M, Goldstein SD. Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation. Int J Radiat Oncol Biol Phys. 1988;15:1065–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Marks J, Mizrahi B, Dalane S, Nwezw I, Marks G. Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc. 2010;24:2700–7.CrossRefPubMedGoogle Scholar
  33. 33.
    MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243(1):132–9.CrossRefGoogle Scholar

Copyright information

© Springer Japan 2018

Authors and Affiliations

  • Cristiano Germano Sigismondo Hüscher
    • 1
  • Cecilia Ponzano
    • 1
  • Gilda Marzullo
    • 1
  1. 1.General and Oncologic Surgery DepartmentRummo HospitalBeneventoItaly

Personalised recommendations