# Combined TaTME with SP Robot for Low Anterior Resection in Rectal Cancer: rSPa TaTME

## TL;DR

This paper introduces a new surgical method combining robotic and transanal techniques for rectal cancer, showing it is safe and effective.

## Contribution

The novel contribution is the combined use of robotic and transanal approaches for distal rectal cancer resection.

## Key findings

- All ten patients had negative surgical margins with acceptable lymph node harvests.
- No local or distal recurrences were observed during a mean follow-up of 20 months.
- Nine out of ten patients had their ileostomy reversed, indicating good recovery.

## Abstract

Transanal total mesorectal excision (TaTME) has been utilized to overcome the difficulties associated with distal proctectomy. At the same time, single-port robotic abdominal (rSPa) procedures allow minimally invasive, single-incision abdominal dissection during proctectomy (rSPa TaTME). We are reporting our initial experience with ten patients who underwent combined single-port robotic abdominal and TaTME approaches for the resection of distal rectal cancers. The benefits of this approach are that (1) the defunctionalizing stoma is placed at the SP site, so there is no appearance of incisions, and (2) the TaTME approach facilitates distal TME and anastomosis after the resection of very distal tumors, even in anatomically challenging pelvises, while maintaining oncologic principles. As such, rSPa TaTME can be considered a safe and feasible approach with appropriate experience, demonstrating good medium-term oncological and surgical outcomes.

Background: Total mesorectal excision (TME) remains the gold standard for the resection of rectal cancer regardless of the modality: open, laparoscopic, or robotic. The transanal TME (TaTME) approach has been utilized to overcome the difficulties encountered with the dissection of tumors in the distal pelvis. Recently, a single-port robotic approach (rSPa) was introduced, where three arms and a camera emanate from a 2.5 cm diameter port. This report presents the first experience in the United States combining those two approaches (rSPa TaTME) in rectal cancer, evaluating its safety and oncologic outcomes. Methods: This is a retrospective review of our prospectively maintained rectal cancer database. Patient demographics, tumor characteristics, neoadjuvant treatment, and oncologic and surgical outcomes were recorded. Results: Between May 2022 and August 2024, ten patients (six females, four males) with a median age at surgery of 53 years (range: 38–85) and a mean BMI of 26 (±5) kg/m2 were included for analysis. The median distance of tumors from the anorectal junction was 3.2 cm (range: 2–5.3 cm). All patients had negative margins, with eight complete TME specimens, one near complete, and one incomplete. The mean number of lymph nodes harvested was 24 (±11). The average operative time was 351 (243–411) min. The average length of stay was four days. The ileostomy was reversed in nine out of ten patients. Six patients experienced complications within 30 days of surgery. There were no local or distal recurrences, with a mean follow-up of 20 months (range: 4–30). Conclusions: rSPa TaTME is a unique and innovative method of combining two minimally advanced approaches for the resection of distal rectal cancers, with acceptable surgical and oncologic outcomes.