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Chouhan et al. Mini-invasive Surg 2018;2:18 I http://dx.doi.org/10.20517/2574-1225.2018.40 Page 5 of 7

Studies have shown that precise dissection of the lower rectum, in particular intersphincteric dissection, is
associated with better long term functional and oncological outcomes [38,39] . The robotic platform allows for a
very precise dissection of the lower third of the rectum in the very confined space of the deep pelvis. Precise
robotic intersphincteric dissection also potentially reduces the duration of the perineal procedure [40,41] .

Transanal TME vs. robotic TME
Despite advances in surgical management of rectal cancer, and advances in different minimally invasive
approaches, achieving negative CRM remains a challenge, particularly in rectal tumours in the lower 1/3 .
[42]
To overcome this, and to avoid higher costs associated with robotic procedures, taTME has emerged as
a new technique for performing rectal dissection [43,44] . Proponents of taTME believe that this is the best
approach for rectal dissection, as this technique offers great access to distal 1/3 rectal dissection, a good view
of the pelvic anatomy, the ability to define the distal resection margin and potential for double purse-string
anastomosis. A multicentre study comparing robotic TME to taTME has found that high quality TME
can be achieved by both robotic and transanal approaches in skilled hands . However, long term data on
[45]
oncological and functional outcomes of taTME are yet to be established.

CONCLUSION
Robotic rectal cancer surgery is safe and feasible and overcomes some of the shortcomings of laparoscopic
surgery. This may be the reason why robotic surgery has better oncological and functional rates, along
with lower conversion rates when compared with laparoscopic surgery. However, robotic surgery is yet to
be compared with open surgery, “the gold standard of rectal cancer resection”. The higher costs associated
with robotic surgery have been the major drawback in uptake of robotic surgery worldwide . However,
[46]
new robotic platforms coming out in the future may reduce the cost of robotic surgery. Surgery technology
continues to advance in order to overcome the limitation of current surgical practice. Innovation is rapid, but
adoption of new technology occurs over time. Further prospective clinical trials will verify the true role of the
robot in rectal surgery.

DECLARATIONS
Authors’ contributions
All authors made substantial contributions to: conception, design, acquisition and drafting the article and
revising it critically for important intellectual content; and gave final approval of the version to be published.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.