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Jahansouz et al. Mini-invasive Surg 2021;5:1 I http://dx.doi.org/10.20517/2574-1225.2020.82 Page 11 of 13

While randomized control trials and head-to-head studies are lacking, the accumulated evidence suggests
that the conventional and robotic approaches are similar in their clinical efficacy. However, differences exist
and are mostly related to the higher cost of the robotic platform. While proponents of laparoscopy would
highlight these cost-related factors, one cannot overlook the improved ergonomics of robotic surgery given
the physical constraints of transanal surgery. Also, the gained articulation and dexterity not only allow for
easier closure of defects, but may also facilitate the resection of larger lesions in multiple quadrants [8,36] .
Future advancements in robotic technology, particularly with the introduction of single-port robotic
systems, will continue to make this platform an attractive alternative in rectal surgery.

It is important to note that in either approach, obesity still remains a factor in contributing to longer
operative times [36,51] . Undoubtedly, transanal surgery will continue to evolve as both conventional and
robotic technologies advance and evolve, creating for an everchanging landscape for the colorectal surgeon.
Should the clinical efficacy of the two approaches remain similar, the most important factors that remain
will then be surgeon preference and comfort level.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Jahansouz C, Arsoniadis EG, Sands DR
Performed data acquisition, as well as provided administrative, technical, and material support: Jahansouz C,
Sands DR

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) 2021.

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