Prospective Analysis of Autonomic Nerve Preserving Robotic Rectal Cancer Surgery Using Indian SSI Mantra Robot: A...

Minimally invasive surgery (MIS) has revolutionized rectal cancer treatment by reducing postoperative pain and hospital stay and improving recovery. Total mesorectal excision (TME), introduced by Heald, is the gold standard for rectal cancer and emphasizes autonomic nerve preservation, which is crucial for bowel, bladder, and sexual function. Robotic systems, Like the Indian SSI Mantra Robot, address the challenges of laparoscopy, offering enhanced dexterity and 3D vision, especially beneficial in the narrow pelvis. This prospective study included 92 patients with biopsy-proven rectal adenocarcinoma who underwent robotic surgery using the SSI Mantra system between November 2023 and March 2025. Key intraoperative, postoperative, and functional outcomes were analyzed. Detailed description of port placement, patient positioning, and nerve-preserving dissection techniques has been explained in this study. Among 92 patients (64% male, median age 56), most had middle (51%) or low (34%) rectal tumors. Neoadjuvant therapy was used in 95% of patients. Sphincter-preserving surgery was achieved in 88%. Median operative time was 220 min, with low blood loss (157 ml) and a 2% conversion rate. R0 resection was achieved in 98.9%, with a mean of 21 lymph nodes harvested. Early recovery was favorable: 98% resumed oral diet on day 1, with low morbidity (13% minor, 2% major complications) and no mortality. Bladder dysfunction occurred in ~ 10% and sexual dysfunction in ~ 20%. Average hospital stay was 4.9 days. Results were found to be comparable to our own results of robotic rectal cancer surgery on a well-established Da Vinci robot system. The Indian SSI Mantra Robot is a safe and effective platform for rectal cancer surgery, delivering excellent oncologic and functional outcomes, comparable to established robotic systems like Da Vinci. This study supports its wider adoption in colorectal MIS.