Abstract / Summary
Abstract Background Low colorectal anastomosis after total mesorectal excision remains technically challenging, particularly in a narrow pelvis. Transanal transection and single-stapled anastomosis can avoid intersecting staple lines by permitting distal rectal transection and purse-string construction under direct visualization. We describe robotic-assisted and transanal minimally invasive surgery single-stapled anastomosis (RaTASS), combining robotic total mesorectal excision with TAMIS-assisted distal rectal control. Methods The operative technique is demonstrated in two patients undergoing low rectal resection. Two workflows are presented: a combined abdominal–transanal approach and a sequential TAMIS-first approach. Following robotic total mesorectal excision, or preceding it in the sequential approach, the distal rectum is closed with a purse-string and transected circumferentially through a TAMIS platform. The distal rectal cuff is subsequently prepared under robotic visualization and a double purse-string, single-stapled colorectal anastomosis is constructed. Results Both procedures were completed without conversion or intraoperative complications. Operative time was approximately 5 h and estimated blood loss was 200 mL in both cases. Histopathological examination demonstrated negative distal and circumferential resection margins in both patients. Conclusions RaTASS is a hybrid technique combining robotic TME with TAMIS-assisted distal rectal transection and single-stapled reconstruction. The technique permits direct visualization during distal rectal closure and cuff preparation and can be performed using either simultaneous or sequential abdominal–transanal workflows. Further evaluation is required to establish its reproducibility and clinical outcomes.