Totally robotic single docking low anterior resection for rectal cancer: pearls and pitfalls

Total robotic resection of mid- and low rectal cancers confers technical advantages within the confines of the pelvis and allows difficult rectal cancer cases to be performed efficiently with less risk of conversion to open. To maximize the advantage of robotic surgery, we utilize the technique of single docking totally robotic dissection for rectal cancer for both the Da Vinci Si and Xi Surgical Systems. All steps are performed robotically, with the surgery divided into two phases. The first phase consists of inferior mesenteric artery and vein ligation, sigmoid and descending colon mobilization and splenic flexure takedown. Phase two is rectal dissection and pelvic total mesorectal excision. In this article, which is complemented by a video, we describe in detail our surgical technique for totally robotic dissection for rectal cancer using a standardized 'medial to lateral' approach with emphasis on the pearls and pitfalls of this surgery.