Laparoscopy constitutes the actual standard of care in minimally invasive surgery for colorectalcancer. However, laparoscopy shows technical limitations in several situations which mayresult in suboptimal post-operative recovery outcomes and long-term survival outcomes. Forinstance, technical limitations during laparoscopic total mesorectal excision cause significantincidence of conversion to open surgery and led to the development of the challenging transanaltotal mesorectal excision as an adjuvant procedure.

The emergence of robotic surgery and the increased availability of commercial roboticplatforms have drawn a significant interest motivated by the wish to overcome the limitationsof laparoscopy during minimally invasive colorectal procedures, notably during minimallyinvasive total mesorectal excision.

In the present privat-docent thesis, we review the latest evidence on the role of robotics in rectalcancer surgery.

In a systematic review and meta-analysis of randomized controlled trials, we show that robotictotal mesorectal excision leads to decreased incidence of conversion to open surgery, increasedproportion of complete total mesorectal excision and decreased proportion of positivecircumferential resection margin when compared to laparoscopic total mesorectal excision, atthe cost of a longer operative time. Long-term analysis of the existing randomized controlledtrials will show if the improved pathological outcomes found with the robotic approach willtranslate into better survival outcomes or not.