The practice of colorectal surgery has undergone signicant transformation in the past three decades, primarily due to the increasing adoption of minimally invasive techniques following the introduction of laparoscopic colectomy by Jacobs [1]. These minimally invasive approaches have demonstrated enhancements in postop­erative recovery, along with reductions in morbidity and length of hospital stay as compared to traditional open surgery for colorectal procedures [2].

The application of robotic surgery has witnessed a remarkable expansion across various surgical disciplines, with a particular focus on colorectal procedures. This surge in adoption can be traced back to the early twenty-rst century when initial reports surfaced regarding the successful implementation of robotic technology in colonic and rectal resections [4, 7]. In a recent extensive analysis encompassing a 16-year period and involving a substantial cohort of 318,548 patients with rectal adenocarcinoma in the United States, notable shifts in treatment modalities and outcomes were identied. The study brought to light a substantial decline in the utilization of open surgery, showing a signicant 50% reduction from 60.1% during period 2 to 30.1% in period 4. In tandem with this decline in open surgery, there was a noteworthy surge in the adoption of minimally invasive surgery, with robotic sur­gery leading the way with a remarkable more than ve-fold increase [4]. This para­digm shift in surgical approaches can be attributed, in large part, to the perceived advantages associated with robotic surgery. The heightened precision, improved visualization provided by a three-dimensional view, stable camera function, and articulated instruments are factors that have contributed to the growing appeal of robotic-assisted procedures. Among the minimally invasive options, robotic surgery has particularly stood out as a favored choice. The pivotal year 2015 emerges as a key turning point in this trend. This coincides with a notable uptick in the adoption of robotic surgery. Intriguingly, this timeframe aligns with the publication of the ALaCaRT trial in the same year [8]. The ALaCaRT trial ndings were instrumental, revealing that laparoscopic surgery did not establish non-inferiority compared to open surgery for patients with T1 to T3 rectal cancers. The uncertainties arising from this trial seemingly inuenced the medical community’s approach to rectal cancer treatment, prompting a shift toward alternative methods, with robotic sur­gery emerging as a compelling choice. In summary, the ndings from this compre­hensive study underscore a substantial evolution in the landscape of rectal adenocarcinoma treatment in the United States. The signicant decline in open sur­gery, coupled with the remarkable increase in minimally invasive approaches, par­ticularly robotic surgery, reects a dynamic response to emerging clinical evidence and a pursuit of more advanced and effective treatment strategies in the ever­evolving eld of oncology.

The purported advantages of utilizing the robotic platform are not only under­scored in observational studies [9, 10] but are also synthesized from comprehensive literature reviews [11, 12]. However, despite the promising outlook, ndings from randomized control trials (RCTs) and a meta-analysis incorporating RCT data have,

Robotic rectal surgery distinguishes itself with its advanced capabilities, providing unparalleled optics and heightened visualization of the intricate autonomic nervous plexus within the pelvis. This elevated visual acuity serves as a powerful tool for pre­cision, empowering surgeons to engage in meticulous preservation of nerves. Advocates of the total robotic technique posit that this meticulous preservation,