Robotic Transanal minimally invasive surgery for rectal neoplasms: A systematic review of outcomes and innovations

This systematic review synthesizes current evidence on robotic transanal minimally invasive surgery (TAMIS) for rectal neoplasms, analyzing data from 26 clinical studies (2011-2024) involving 1,284 patients. The findings demonstrate robust short-term oncologic outcomes, including an 89.1% R0 resection rate for malignant lesions and an 8.3% local recurrence rate at a median follow-up of 28 months. Technical advancements, particularly the development of single-port robotic systems, have yielded significant improvements in procedural efficiency, reducing operative time by 22% while enhancing surgical ergonomics. Comparative analyses reveal advantages over conventional endoscopic TAMIS, including lower conversion rates (4% vs. 12%) and superior maneuverability in confined spaces. However, the review identifies persistent knowledge gaps regarding long-term survival outcomes and cost-effectiveness that require further investigation through prospective trials. The current evidence supports selective use of robotic TAMIS in specialized centers for carefully selected cases, particularly early-stage adenocarcinomas and complex benign lesions, while highlighting the need for standardized training protocols and economic evaluations.