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Kunkel et al . Mini-invasive Surg 2020;4:27 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.05

Perspective Open Access

From TATA to single port robotic (SPr) taTME:

approaches to distal rectal cancer

Emily Kunkel, Samir Agarwal, Charles Martin, Henry Schoonyoung, John H Marks

Department of Colon and Rectal Surgery, Lankenau Medical Center, Wynnewood, PA 19096, USA.
Correspondence to: Dr. Emily Kunkel, Department of Colon and Rectal Surgery, Lankenau Medical Center, Wynnewood, PA
19096, USA. E-mail: kunkel2@mlhs.org
How to cite this article: Kunkel E, Agarwal S, Martin C, Schoonyoung H, Marks JH. From TATA to single port robotic (SPr)
taTME: approaches to distal rectal cancer. Mini-invasive Surg 2020;4:27. http://dx.doi.org/10.20517/2574-1225.2020.05
Received: 9 Jan 2020 First Decision: 18 Feb 2020 Revised: 4 Mar 2020 Accepted: 9 Mar 2020 Published: 16 May 2020

Science Editor: Giulio Belli Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
The surgical management of rectal cancers located in the distal rectum presents a unique challenge for surgeons as it
is anatomically unfavorable and technically difficult to access. Over the course of the 20th century, novel techniques
contributed to the improvement of rectal cancer management and led to improved quality of life for patients following
surgical resection. In this article, we explore the background of rectal surgery techniques, which have progressed from
abdominal perineal resection to transanal abdominal transanal proctosigmoidectomy, transanal total mesorectal excision
(taTME), and ultimately minimally invasive transanal sphincter preserving techniques utilizing single port robotic
technology (SPr taTME). In the first clinical experience with the DaVinci SP robot in the United States, we are finding
many advantages of this new platform in transanal surgery. The SP offers superior image quality with 3D view, wristed
instruments facilitating ergonomics, and superior surgical precision.

Keywords: Transanal abdominal transanal, transanal minimally invasive surgery, da Vinci single-port robot, transanal,
rectal cancer

INTRODUCTION
“An invention has to make sense in the world it finishes in, not in the world it started.” Tim O’Reilly.

For a large portion of the 20th century, low-lying rectal cancers were commonly treated by performing
[1]
an abdominoperineal resection (APR), first reported by Miles in 1908 [Figure 1]. While the APR is
oncologically effective, it distinctly alters the gastrointestinal anatomy and leaves the patient with a
permanent colostomy. This procedure was adopted as standard treatment for rectal cancer for much of the

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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