Robotic Transanal Surgery and Navigation for Rectal Neoplasia

The advent of transanal minimally invasive surgery (TAMIS) [1] led to a general broadening of the scope of potential applications through newfound access platforms and techniques. The purpose of robotics in surgery is currently being redefined. Although initially designed as a telesurgical platform [2, 3], robotics in the practice of colorectal surgery, like other specialties, has focused on demonstrating superiority over laparoscopy [4–6]. However, a fresh perspective has gradually emerged, whereby the focus of robotics has shifted to exploring options and routes of access to anatomic targets in ways not otherwise possible [7]. In other words, the objective for robotics will be not to compare it to laparoscopy but rather to apply it in ways which were heretofore inconceivable. This is precisely the impetus behind next-generation flexible robotic systems which will prove invaluable for hard to access targets, such as the oropharynx, pulmonary system, alimentary tract, and pelvic cavity. This chapter examines how robotics can be applied to rectal cancer surgery, and specifically TAMIS and taTME. Future directions, including stereotactic navigation and new robotic platforms, are also discussed. References 1. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2010;24(9):2200–5. 2. Marescaux J, Leroy J, Rubino F, Smith M, Vix M, Simone M, Mutter D. Transcontinental robot-assisted remote telesurgery: feasibility and potential applications. Ann Surg. 2002;235(4):487. 3. Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK. Transatlantic robot-assisted telesurgery. Nature. 2001;413(6854):379. 4. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL. Robotic versus laparoscopic colectomy. Surg Endosc. 2007;21(10):1701–8. 5. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Annals Surg Oncol. 2009;16(6):1480–7. 6. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. Jama. 2017;318(16):1569–80. 7. Atallah S. Assessment of a flexible robotic system for endoluminal applications and transanal total mesorectal excision (taTME): Could this be the solution we have been searching for? Tech Coloproctol. 2017;21(10):809–814. 10.1007/s10151–017–1697–6. Epub 2017 Oct 24.