Keywords
Minimally invasive surgical procedures
Surgical oncology
Robotic surgical procedures
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Abstract
Objective: To evaluate how minimally invasive techniques (laparoscopy, robotics, and taTME) impact sphincter preservation in rectal cancer. Literature review: Laparoscopy offers faster recovery, less blood loss, and pathological results comparable to open surgery, but faces limitations in narrow pelvises, obesity, and low rectal tumors, increasing conversion rates. Robotic surgery overcomes these barriers with 3D vision and articulated instruments, reducing conversions, facilitating pelvic dissection, and expanding the feasibility of intersphincteric resections while preserving urinary continence and sexual function. taTME, with its “bottom-up” approach, improves distal margins and access to the lower rectum, increasing anal canal preservation rates when performed by experienced teams. For early tumors, TAMIS/TEM allow local excision with minimal trauma and rectal preservation in carefully selected cases. Neoadjuvant protocols (including TNT) reduce tumor volume, increase R0 resections, and favor preservation strategies. Final considerations: Minimally invasive techniques, integrated with appropriate selection and neoadjuvant management, increase the likelihood of sphincter preservation without compromising oncological control; limitations lie in the learning curve and variability among centers.
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