Invited Lecture(JSGS)
Fri. November 6th   14:00 - 14:30   Room 2: Kobe International Exhibition Hall No.2 Building Hall (South)
Invited Lecture15
 Robot assisted minimally invasive surgery vs transanal total mesorectal excision for rectal cancer: Local experience
Choon Seng Chong
National University Hospital Singapore
Since 1980’s, after the description of Total Mesorectum Excision by Bill Heald, local recurrence rates have dramatically decreased from old records of over 30% to 2.7% (1). However, the narrow pelvis especially in males continues to pose a challenge for surgeons. Within a confined space, surgeons are expected to perform sharp and clean dissection, respecting critical and functional structures like the pelvic nerves and content with the limited maneuverability of standard laparoscopic instruments. This fueled the innovation of robotic surgery in colorectal with the first few cases reported in 2002 (2). Despite the failure of demonstrating significant oncological differences between robotic and laparoscopic rectal cancer surgery (3), the DaVinci Intuitive system remains largely in use in advanced colorectal cancer centers around the world including USA, Japan, Korea and Singapore.
After barely another decade, yet another innovation known as Transanal Total Mesorectum Excision (taTME) started in 2010 (4). This innovation crystalized a novel approach to an old problem often faced from the top-down approach. By beginning the surgery from the bottom-up approach, the dissection happens at the closer view and at a straight on perspective which overcomes the challenge traditional laparoscopic or robotic approaches have and typically results in conversion to open. From a population-based study and a recent meta-analysis, conversion rates even in the most experienced hands, ranges from 8-10% for laparoscopic rectal surgery (5-6). The rates are similar for robotic surgery based on ROLARR trial (3).
We describe our local experience about this aspect and compare it to international standards.
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