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Yellinek et al. Mini-invasive Surg 2018;2:22 I http://dx.doi.org/10.20517/2574-1225.2018.17 Page 5 of 7

day surgical complication rate was 37.5% (Clavien-Dindo 1 in four patients, 2 in one patient and 3 in one
[33]
patient who developed anastomotic leak). Carvello et al reported a case of TaTME assisted laparoscopic
[34]
TPC + IPAA for familial adenomatous polyposis (FAP) with satisfactory results. Ambe et al. reported
their experience with 8 patients who underwent TaTME assisted laparoscopic TPC + IPAA for FAP. In all
cases, surgery was successfully completed using TaTME and no perioperative complications were recorded.
[35]
Trépanier et al. described their technique and experience with 10 patients who underwent reversal of
Hartmann’s procedure using combined laparoscopic and TaTME approaches. Indications for Hartmann’s
procedure were complicated diverticulitis, anastomotic leak, and rectosigmoid cancer. Reconstruction
was achieved in all patients. One low colorectal anastomosis was hand sewn and the other 9 were stapled.
Diverting loop ileostomies were created in five patients and all were closed during the following year. One
case required hand-assistance but there was no conversion to open surgery. Three patients had a total of
four post-operative complications, none of whom required reoperation.

Robotic technology includes 3-D optical visualization, ambidextrous movements, a tremor filter, and more
degrees of freedom of the effector tip movement than standard instruments. These theoretical benefits may
be of specific significance in confined spaces. Recently, Intuitive Surgical (Sunnyvale, California) launched
the da Vinci® single port platform. The device combines a single site port with flexible robotic arms and in-
struments and improved ergonomics. Its use has mainly been described in gallbladder resections, gyneco-
[38]
logical operations, and urological procedures [36-39] . Jiménez-Rodríguez et al reported two cases of robotic
low anterior resection with reduced ports, using the single-port robotic platform. There were no intraop-
[38]
erative complications and the pathology report showed complete TME specimens . Atallah et al reported
the first clinical case of robotic transanal TME in a patient with a T3N1 rectal tumor located 4 cm from the
anal verge. There were no complications, negative distal and circumferential margins were achieved, and
[41]
[40]
the specimen quality was near-complete . Verheijen et al. reported their first case of robotic TaTME
without complications and histology showed a complete mesorectal excision with free distal and circum-
[42]
ferential margins. Marks et al . reported the successful transanal use of the single-port system robotic
platform (SPS) on four cadavers. There were no piecemeal or fragmented resections and, subjectively, clo-
sure was deemed good-to-excellent in all cases. Surgeon assessment of setup and performance of the SPS
[44]
was excellent in all cases [42,43] . Kuo et al. reported the largest series to date of 15 consecutive patients with
ultra-low rectal tumors who underwent robotic TaTME followed by trans-abdominal robotic single port
proctectomy and one additional port. The median number of lymph nodes harvested was 12. All patients
[44]
had negative circumferential and distal resection margins .
[43]
Huscher et al. reported seven cases of TME using a hybrid technique combining robotic TaTME and lap-
aroscopic abdominal procedure (vessel division and colon mobilization). Macroscopic assessment showed
complete mesorectum in six cases and near complete mesorectum in one case, the mean number of lymph
[43]
nodes was 14 and DRM and CRM were negative in all cases .

CONCLUSION
TaTME offers several potential advantages compared to standard transabdominal TME. Several trials are
currently underway to test this hypothesis. The single port robot may further facilitate introduction and
adaptation of the TaTME method of TME.

DECLARATIONS
Author’s contribution
Writing manuscript, critical review and final edits: Wexner SD
Writing manuscript and final edits: Yellinek S