Transanal endoscopic microsurgery is a safe and efficacious surgical approach for local excision of benign adenomas and early-stage rectal cancer. However, utilization of the technique has been limited due to the unavailability of high-priced specialized instrumentation at many institutions and the technically demanding training required. To avoid these obstacles, we have explored an alternative approach called Transanal Endoscopic Video-Assisted excision, which combines the merits of single-port access and local transanal excision. A disposable single-incision port is inserted into the anal canal for transanal access. The port contains 3 cannulae for introducing instrumentation into the rectal lumen, and a supplementary cannula for carbon dioxide insufflation. Pneumorectum results in rectal distention and optimizes the visual field during the procedure.

Robotic single-port platforms represent a viable option for advanced surgical procedures. This preclinical study investigated the dual-field, single-port, robot-assisted transanal total mesorectal excision taTME. We evaluated the feasibility of the one-team approach. A good quality specimen was achieved. The surgeon comfort was high during simulated surgery.

Even with considerable operator experience and expertise, surgical access from the abdomen to the mid and low rectum and mesorectum can be difficult, especially in male and obese patients. This holds true whether the approach from above is performed by laparoscopy or laparotomy. While conventional operations that include extirpation of the anal canal and sphincters of course incorporate a perineal approach for the lowermost aspect of the proctectomy, their efficiency in cephalad extension is limited by difficulties in access and visualization. This can be done in concert with or without sphincter excision and should both enhance the quality of the surgical specimen and minimize the potential for collateral damage in dissection.