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?
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Experimentation with robotic transanal surgery (RTS) began in 2011  as a natural evolution of transanal minimally invasive surgery (TAMIS) . Using first-, second-, and eventually third-generation multi-arm Da Vinci S, Si, and Xi master–slave robotic systems (Intuitive Surgical Systems, Sunnyvale, CA, USA), RTS has evolved from endoluminal applications  (most notably for local excision of rectal neoplasia) to subsequent use as a platform for transanal total mesorectal excision (taTME), with the first such case reported in 2013 . To date, several feasibility studies and pilot investigations with RTS have been described for local excision and taTME [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19], leading some surgeons to believe that transanal approaches could represent a “sweet spot” for robotics in colorectal surgery  and a solution to its Achilles’ heel [21, 22]. While RTS can achieve extreme operative precision, the principle shortcoming of the...
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Conflicts of interest
S Atallah is a paid consultant for ConMed, Inc, Applied Medical, Inc, THD, America, and has an ongoing consultant relationship with Medicaroid Robotics and MedRobotics, Inc. This research was supported by MedRobotics, division of Colorectal Surgery, Research and Development.
This research was performed in accordance with the ethical standards of the institutional and/or national research com- mittee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was not applicable as the work represented herein did not involve human subjects. Cadaveric research was conducted in accordance with the standards set forth by ethics and hospital regulations.
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