title: Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery.
abstract: BACKGROUND
  In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge.
  
  
  OBJECTIVE
  To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer.
  
  
  METHODS
  The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM).
  
  
  RESULTS
  The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision).
  
  
  CONCLUSIONS
  This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.
authors.affiliation: Cancer National Institute, Rio de Janeiro, RJ, Brazil.
authors.forename: Carlos Ramon Silveira
authors.initials: CR
authors.lastname: Mendes
authors.affiliation: Cancer National Institute, Rio de Janeiro, RJ, Brazil.
authors.forename: Marcus
authors.initials: M
authors.lastname: Valadão
authors.affiliation: Cancer National Institute, Rio de Janeiro, RJ, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Araújo
authors.affiliation: Cancer National Institute, Rio de Janeiro, RJ, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Linhares
authors.affiliation: Cancer National Institute, Rio de Janeiro, RJ, Brazil.
authors.forename: José Paulo
authors.initials: JP
authors.lastname: Jesus
mesh_terms: D001003:Anal Canal; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*