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Page 2 of 3 Buchanan. Mini-invasive Surg 2019;3:8 I http://dx.doi.org/10.20517/2574-1225.2019.24

[4]
Yellinek and Wexner , writing from the Cleveland clinic, discuss an alternative to the robot, namely
transanal total mesorectal excision (TaTME), the importance of a registry and training programme though
conclude that the single port robot may provide a method for better adopting this technique, potentially as
[5]
a combined approach and ongoing trial data is awaited. De Nardi suggests that TaTME has comparable
functional outcomes compared with the abdominal approach though the COLOR III trial results are
eagerly awaited to assess this.

[6]
Ishida et al. recognise the difficulty associated with learning reduce port surgery, though again note
that this technique once mastered may yield benefits in terms reduced operating time over single incision
laparoscopic surgery, particularly with advancements in needlescopic surgery.

[7]
Ambe and Möslein discuss the role of extended resections in certain mutational and hereditary analyses,
making the point that each case must be considered on its own merits after fully informed discussion with
patients about the risks and benefits of each approach - this detailed piece provides an up to date review of
most of the important hereditary and mutational conditions, how they are classified and defined as well as
many operative illustrations pointing out the various surgical approaches possible.

[8]
Kumar looks beyond TME and the role of MIS surgery in exenterative surgery, pelvic lymphadenectomy
and even abdomino-sacral resection.

[9]
Funahashi and colleagues outline their experience in Japanese patients of intersphincteric resection
in low lying rectal cancer and how it can lead to organ preservation in many without compromising
pathological outcomes - they notes the improved quality of life after preserving as much of the internal
anal sphincter as possible.

[10]
O’Donohue et al. explore whether laparoscopic rectal surgery is non inferior, particularly assessing the
COREAN, ALaCaRT and ACOSOG Z6051 trials. The concept of non-inferiority in the short term, vs.
equivalent long term outcomes should not cloud the picture of the many advantages of an MIS approach,
that are likely to be borne out with larger population based studies.

[11]
Westwood and West emphasise how pathologists enhance feedback and thus quality of rectal cancer
specimens and thus, patient outcomes. This quality control was largely the work of Quirke, coupled with
imaging expertise from Brown G working with resection material generated via Heald in TME surgery
- initially surgeons felt affronted by resections being graded though with importance on outcome, now
entirely value the essential role of feeding this back via their multidisciplinary teams.

[12]
Erkan, Kelly and Monson in Florida review the role of the transanal minimally invasive surgery
(TAMIS) platform in locally resecting rectal cancer, particularly in T1 lesions or after chemo-radiotherapy
[13]
and more controversially T2/4 lesions even in palliative scenarios - again Adegbola et al. from St Mark’s,
UK, additionally discuss the role of TAMIS with a robotic platform in exenterative surgery and other
scenarios - i.e., trying to avoid major resectional surgery altogether.

[14]
Myint discusses the alternative of brachytherapy to radical resection and that patients with knowledge of
this may reject MDT recommendations in favour of a more conservative approach - the OPERA database
(organ preservation) will help provide useful outcome information in this regard.

All of these articles are well written and many beautifully illustrated, giving a concise appraisal of state of
the art techniques. Some highlighted above do not take away all the other well-constructed opinion pieces
that expand on the themes generated through principles of TME surgery and multidisciplinary input into
this group of patients.