Vol.:(0123456789) 1 3 Journal of Robotic Surgery https://doi.org/10.1007/s11701-019-01032-y ORIGINAL ARTICLE Hybrid abdominal robotic approach with conventional transanal total mesorectal excision (TaTME) for rectal cancer: feasibility and outcomes from a single institution Amanda Nikolic 1,2  · Peadar S. Waters 1,4  · Oliver Peacock 1,4  · Colin Chan‑Min Choi 1  · Amrish Rajkomar 1  · Alexander G. Heriot 1,4,5  · Philip Smart 1,2,3  · Satish Warrier 1,4,5 Received: 23 April 2019 / Accepted: 5 September 2019 © Springer-Verlag London Ltd., part of Springer Nature 2019 Abstract Total mesorectal excision (TME) is currently recognised as the standard of care for patients with rectal cancer. Complete TME is known to be associated with lower rates of recurrence. Robotic and endoscopic TaTME approaches are reported to offer excellent proximal and distal rectal dissection into the TME plane, however, combining both approaches in a hybrid procedure could potentially optimise visualisation of the dissection plane and confer improved circumferential and distal margin rates. The aim of this study was to analyse the feasibility of a hybrid robotic abdominal approach with conventional TaTME for rectal cancer. Furthermore, pathological and patient outcomes were assessed. A review of prospectively main- tained databases was undertaken to assess all patients undergoing robotic TME surgery for rectal tumours from August 2016 to October 2017. Patient demographics, tumour characteristics and outcomes were collated from patient charts and hospital databases. All patients underwent a modified Cecil approach after multidisciplinary team discussion. Eight patients (7 male, 1 female) underwent a combined hybrid approach with a median age of 60 years (range 47–73) and BMI of 29.5 (range 20–39.1) kg/m 2 . Median distance from the anorectal junction (ARJ) was 7.5 (range 4–13) cm. Six patients underwent neoadjuvant treatment with chemoradiotherapy. Patients had a median length of stay (LOS) of 9 (range 4–33) days. There were no intra-operative complications encountered and no patients required a conversion to an open procedure. Complica- tions included one anastomotic leak and one presacral collection. All patients had a complete TME with RO resection with a median number of lymph nodes harvested was 22 (range 6–37) lymph nodes. This hybrid technique is a feasible, practical and operatively favourable approach to rectal cancer surgery with initial pathological outcomes and complication profile equivalent to other approaches. Keywords Robotic surgery · Rectal cancer · Pelvic malignancy · Sphincter preservation · TaTME · Total mesorectal excision · Hybrid surgery Introduction Total mesorectal excision (TME) is recognised throughout the literature as standard of care for the management of patients with rectal tumours [1]. It is a surgical technique, Amanda Nikolic and Peadar S. Waters are the co-first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11701-019-01032-y) contains supplementary material, which is available to authorized users. * Satish Warrier satish96101@yahoo.com 1 General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Richmond, Australia 2 Department of Surgery, The Surgery Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084, Australia 3 Department of Surgery, Eastern Health, 5 Arnold Street, Box Hill, Melbourne, VIC 3128, Australia 4 Colorectal Surgery Unit, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia 5 The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia