Technical aspects of robotic proctectomy

Robotic proctectomy is at the forefront of surgical innovation, and interest in this technique is rapidly increasing. The advantages of robotic techniques, such as enhanced visualization and improved dexterity along with tireless retraction and the addition of a "fourth arm" are reported to confer an advantage in the pelvis. It is unknown what long-term outcomes may emerge from ongoing clinical trials; however, early studies suggest improved perioperative and oncologic outcomes. Proponents of robotics suggest that robot-assisted procedures are associated with decreased complication rates and fewer conversions to open. This article reviews the pertinent literature on robotic total mesorectal excision and the early reported outcomes. The 3-arm, 4-arm laparoscopic-assisted, and the 4-arm totally robotic techniques for performing robotic proctectomy are described in detail, including port placement and patient position as well as robot docking.