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[91]
[92]
leaks . To improve the accuracy of the transanal dissection, robotic technology could also be helpful .
[93]
Two surgical teams (abdominal and perineal) can work together with the new platforms . At present,
however, further investigations are still needed to assure the long-term functional, and more critically, the
oncological outcomes of the transanal approach for resecting rectal tumors .
[94]

CONCLUSION
The use of robotic assistance provides interesting improvements that may overcome some of the technical
limitations of conventional laparoscopic instruments. Acceptable oncologic outcomes have been similarly
reported. Increased costs, poor availability, and special training requirements are still important barriers
to be overcome. Surgeons and health-care providers should notice that no important benefits have been yet
demonstrated for robotic TME compared with the other available surgical alternatives. The combination
of emerging technology, technical refinements, and an optimal trainee learning system may allow robotic
surgery to be a gold standard for rectal cancer in the near future.

DECLARATIONS
Authors’ contributions
Concept and design: Sebastián-Tomás JC, García-Granero E, Martínez-Pérez A
Collection and assembly of data: Sebastián-Tomás JC, Santarrufina-Martínez S, Navarro-Martínez S,
Gonzálvez-Guardiola P, Martínez-López E, Payá-Llorente C
Provision of study materials or patients, data analysis and interpretation, manuscript writing and final
approval: All authors

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) 2019.

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