Single-port robotic versus laparoscopic transanal minimally invasive surgery (TAMIS) for rectal neoplasms: a first comparative analysis of surgical efficiency and clinical outcomes.

BACKGROUND

Single-port (SP) robotic platform has recently been applied to transanal minimally invasive surgery (TAMIS). However, comparative data with conventional TAMIS performed using laparoscopic instruments remain limited. This study aimed to evaluate the technical feasibility and short-term outcomes of SP robotic TAMIS compared to laparoscopic TAMIS.

METHODS

Multi-institutional retrospective cohort study of 108 patients (SPR n = 34, LAP n = 74) undergoing TAMIS for rectal neoplasms from January 2016 to September 2025. Patients with benign rectal neoplasms, clinical stage T1N0 with well to moderately differentiated tumor, or low-risk feature tumors were included. Primary outcome was operative feasibility (operative time, full-thickness excision, intraoperative complications). Secondary outcomes included postoperative complications, length of stay (LOS), and pathological safety.

RESULTS

Baseline characteristics were comparable between groups. The distance from anal verge was 6.42 ± 2.45 in the SP robotic group and 7.37 ± 2.53 in the LAP group (p = 0.155). Mean operative time was significantly shorter in the SPR groups (44.6 ± 25.1 min vs. 57.5 ± 28.7 min, p = 0.026). All patients achieved full-thickness resection with negative margins. No intraoperative complications occurred in either group. The length of hospital stay was significantly shorter in SPR groups (1.47 ± 0.99 vs. 2.51 ± 1.13 days, p < 0.001). Comparative video analysis demonstrated superior articulation and visualization in narrow anal canal access in the SPR approach.

CONCLUSIONS

Single-port robotic TAMIS demonstrates comparable technical feasibility and clinical outcomes to conventional TAMIS while offering potential perioperative advantages including shorter operative time and shorter hospital stay with pathological safety.