Learning Curve of Robotic Total Mesorectal Excision versus Transanal Total Mesorectal Excision - A Single-Center Study

Introduction: Rectal cancer treatment has changed over the last several decades. Total mesorectal excision (TME) has proven to be the gold standard in rectal cancer surgery. Transanal total mesorectal excision (TaTME) and robotic total mesorectal excision (RoTME) for low and mid rectal cancer are implemented to overcome some of the difficulties of the laparoscopic approach. The aim of this study is to show a single-center experience in the learning curves of both RoTME and TaTME. Material and methods: A single-center prospective study comparing the first 17 consecutive RoTME cases from January 2016 to May 2019 to the first 16 consecutive cases of TaTME from July 2019 to June 2021 was conducted. The difference in the time periods is due to the later implementation of TaTME in the center. All procedures were performed by a single team. Results: A total of 33 patients were included in the study – 17 RoTME patients and 16 TaTME patients. The groups were homogeneously distributed in terms of patients’ characteristics and stage. Comparing the two groups, no statistically significant differences between them were found in terms of complication rates (p=0.692), positive circumferential resection margins rates (p=0.000), frequency of anastomotic leak rates (p=0.596), time from completion of radiotherapy to surgery (p=0.229) and time from surgery to ileostomy closure (p=0.880). A statistically significant shorter operative time was found in the TaTME group (p=0.008). Conclusion: The learning curve should be considered in all procedures. A structured training pathway for TaTME and RoTME is essential. No differences between robTME and TaTME in the learning curve were observed in our center.