Background Robotic surgery for rectal cancer may be a way to overcome the limitations of laparoscopic surgery. However, totally robotic surgery for rectal cancer is still technically challenging. This report describes the technical details and outcomes of totally robotic rectal surgery. Methods The authors developed a totally robotic surgery technique for rectal cancer and performed it for 45 patients. We designed a six-port system, including a camera port, to perform rectal cancer surgery from the splenic flexure to the pelvic diaphragm in one setup. To check the feasibility and safety of the procedure, perioperative outcomes including conversion rate, morbidity, and mortality were analyzed. Results The mean body mass index of the 45 patients was 23.6 kg/m 2 (range, 18.8-31.6 kg/m2). There was one case (2.2%) of conversion to laparotomy because of a common iliac artery injury. The 30-day morbidity rate was 11.1%. There was no operation-related mortality. Conclusions Totally robotic surgery for rectal cancer using the described technique was feasible and safe. This result could facilitate the spread of robotic surgery for rectal cancer and maximize the advantages of robotic surgery.
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