​This book captures cornerstone developments in a new body of knowledge and provides an expert resource on a “hot topic” in rectal surgery. Transanal minimally invasive surgery (TAMIS) was designed for local excision of select rectal neoplasms, however soon it became realized that the TAMIS technique could be used for applications beyond local excision, most notably for transanal total mesorectal excision (taTME). This new operative technique has revolutionized our approach to the distal rectum by allowing for improved access, especially in obese male patients with an android pelvis, and by minimizing abdominal wall access trauma. The endpoints of improved oncologic resection, as defined by mesorectal envelope completeness, negative circumferential resection margins, and negative distal margin, are assessed. This book details controversies, pitfalls, and future directions of taTME and TAMIS. Chapters are authored by those on the forefront of innovation with TAMIS and taTME, and each is considered an authority on the topic. Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME) is a must-have reference for surgeons who are performing this operation and fellows in training who want to completely understand the various nuances of TAMIS and taTME.

This book describes the various procedures, including surgery through the abdominal wall, through a transanal access or by the union of both, using an open, laparoscopic, or robotic approach. Worldwide pioneers for each technique are invited as authors and portray in step-by-step detail about each procedure. Of the 32 chapters, 23 are dedicated only for the surgical procedures. Each chapter is enriched by numerous figures, which complement the text, permitting the understanding of each surgical technique from its beginning until the last step. Eight additional chapters are dedicated to the clinical and anatomical aspects of rectal cancer. In the last decade there has been an impressive evolution in the treatment of patients with rectal cancer, with a focus not only on the preservation of a cancer-free life, but the quality of that life. This book has been written to be useful for everyone involved in rectal cancer management. From internists, gastroenterologists, endoscopists, oncologists, radiotherapists and radiologists involved in the treatment of rectal cancer during their daily practice, to surgeons specialized in colorectal surgery, to junior faculty to trainees, all interested in new and innovative techniques.

The aim of this thesis was to explore the current state of transanal minimally invasive surgery (TAMIS) in the treatment of rectal cancer. Whilst TAMIS as technique for local excision has been accepted and positively evaluated since the introduction of transanal endoscopic microsurgery (TEM) by Gerhard Buess in 1988, advancement of the TAMIS approach further beyond the rectal wall to achieve a radical transanal total mesorectal excision (TaTME) was first published only in 2010. The perioperative safety of the TAMIS technique for local excision itself has been established over the past decades. Current focus lies in extending the role from benign adenomas and early rectal cancer (T1 limited to the most superficial part of the submucosa) towards local excision of more advanced rectal tumours potentially in combination with (neo)adjuvant chemoradiotherapy in the pursue of organ preservation. For TaTME perioperative safety has not been consistently reproduced at a comparative level as the standard laparoscopic approach and long-term outcomes are scarce and limited to cohort studies. Despite the absence of high-quality evidence supporting the oncologic safety of TAMIS local excision in combination with radiotherapy, various strategies have been already incorporated in institutional practices. Accurate preoperative staging of rectal cancer is of immense importance to offer precise tailored treatment such as organ preservation. Without accurate staging, it can lead to prevent potential under and overtreatment. Multidisciplinary teams rely on the mandatory preoperative MRI to triage patients with rectal cancer in need of neoadjuvant (chemo)radiotherapy. Whilst MRI is excellent to identify enlarged lymph nodes and to determine the growth of the tumour beyond the rectal wall, it underperforms in daily practice to distinguish T1 stage (limited to submucosa) from T2 stage.

This title encompass all current minimally invasive rectal procedures for a variety of benign and malignant indications and provides a compendium of the available data supporting each technique. Procedures are represented both photographically as well as through selected video clips. The video clips are hosted online and provide a valuable addition to the utility of the text. The text has a substantial pathologic emphasis delineating the conditions for which each technique is most suited. It includes established procedures such as laparoscopic proctectomy, but also describes novel approaches that are gaining the attention of professionals throughout the world, such as transanal endoscopic approaches that are being viewed as a bridge toward the natural orifice surgical interventions of the future. The first and only volume dedicated exclusively to advanced minimally invasive rectal surgery and will serve as a precious guide for professionals throughout the world.

Laparoscopic colectomy has been introduced in the early 90ies as a new technique with proven improvement in short and long term outcome. Despite significant patient benefits the overall adoption rate remains low. On the other hand significant more advanced techniques such as single incision laparoscopy, robotics and transanal access surgery have been introduced in the last several years and are rapidly evolving. Therefore a significant gap between the practicing community surgeon and innovator seems to exist. Advanced Techniques in Minimally Invasive and Robotic Colorectal Surgery bridges that gap and provides a foundation summarizing and organizing all classic and new techniques in minimally invasive colorectal surgery available in literature and from masters within the field.It provides tips and tricks that allow the user to move up the learning curve, manage difficult scenarios, overcome challenges, increase the utilization of minimal invasive techniques and decrease the conversion to open surgery. By enhancing the surgical tool box the surgeon will be able to progress from the novice to the master. Rather than describing operative procedures which may be very biased by an individual author, the guide provides alternative building blocks of various difficulty for different procedures which can be then tailored to the patient and surgeon`s own comfort level and experience. Advanced Techniques in Minimally Invasive and Robotic Colorectal Surgery will serve as a inspirational guide for the innovator of the future. It will allow surgeons of all levels to better adapt to inevitable changes in future techniques and will be of great value to general surgeons, colon and rectal surgeons, minimally invasive surgeons as well as residents and fellows.

​The first edition laid out the foundation with laparoscopic and robotic surgery utilizing the Da Vinci SI platform. Since then, many new advances in equipment and surgical techniques are becoming more popular. This second edition expands upon laparoscopic and endoscopic techniques and robotic surgery with the use of the new Da Vinci XI platform. This book bridges the gap between the practicing community of surgeons and the surgical innovators and provides a foundation for all classic and new techniques in minimally invasive colorectal surgery. By enhancing the surgical toolbox, the surgeon is able to progress from the novice to the master. Rather than describing the entire operative procedure by an individual author, this book compares operative steps of various technical difficulties throughout different chapters, thereby allowing the surgeon to tailor surgery to patient and surgeon`s own comfort level and experience. Chapters are written by a myriad of renowned experts in the field and discuss the major advances in advanced laparoscopic and endoscopic, robotic, and transanal minimally invasive surgical techniques. Great emphasis is placed on transanal total mesorectal excision (TaTME), which is dramatically changing the surgical approach to rectal resections. The second edition of Advanced Techniques in Minimally Invasive and Robotic Colorectal Surgery serves as a valuable resource to general surgeons, colon and rectal surgeons, minimally invasive surgeons, as well as residents and fellows.

Cancer of the rectum continues to be a significant health problem in industrialized co- tries around the world. Relative 5-year survival rates in the USA for cancer of the rectum from 1995 to 2001 improved to 65%, a 15% improvement over 20 years (American Cancer Society, 2007). The reasons for this dramatic improvement include more accurate pr- perative staging, aggressive neoadjuvant therapy and improved surgical technique as well as specialty-trained surgeons. Despite advances in nonoperative techniques of radiation therapy, chemotherapy and immunotherapy, surgical extirpation continues to be the cornerstone of curative treatment of this potentially lethal disease. Radical cancer excision with total mesorectal excision has become the preferred surgical procedure for even early-stage cancers of the rectum. Over the past decade the enthusiasm for local excision (and other local treatments) has given way to persuasive (predominantly retrospective) evidence that the incidence of locoregional recurrence due to unsuspected lymphatic metastases and positive lateral margins is un- ceptably high even for stage T tumors. Vigorous attempts to find characteristics of the 1 tumor that would allow successful local treatments are ongoing.