Robotic surgery (R-TAMIS): a systematic review

Robotic transanal minimally invasive surgery (R-TAMIS) is increasingly used for local excision of rectal lesions, offering improved precision, ergonomics and access compared with conventional TAMIS. Although early reviews demonstrated feasibility, pooled data on operative and oncological outcomes remain limited. This systematic review synthesizes contemporary evidence to provide descriptive weighted estimates of procedural efficiency, safety and short-term clinical outcomes. A systematic search of PubMed, Scopus and Web of Science through June 2025 identified studies reporting R-TAMIS outcomes in ≥ 5 patients. Extracted variables included demographics, operative metrics and oncological results. Continuous data were descriptively pooled when possible, and risk of bias was assessed using Joanna Briggs Institute and Newcastle-Ottawa tools. Owing to heterogeneity, findings were summarized qualitatively. Twenty-two studies (n = 437), predominantly case series, met inclusion criteria. The mean patient age was 63 years, BMI 27.5 kg/m2 and ASA score 2.2. Robotic systems used included da Vinci S/Si/Xi/SP and Medrobotics Flex platforms. Mean docking time was 20 min, operative duration 103 min, blood loss 18 mL and hospital stay 1.7 days. Postoperative morbidity remained low (Clavien-Dindo I–II 8%, III 1%) with reoperation and readmission rates of 2%. R0 resection was achieved in 96% of tumors, most of which are early stage (77%). R-TAMIS appears safe and feasible for local excision of early rectal tumors, with descriptive estimates suggesting low perioperative morbidity and short hospital stay. While currently more costly than laparoscopic TAMIS, efficiency gains in high-volume centers may mitigate costs. Further prospective studies are needed to better define outcomes and refine procedural indications.