Initial experience of pure robotic single incision TME with SST technique for middle-low rectal cancer using the da Vinci SP system

To overcome the technique challenge of successful TME and precise distal section of the rectum with free margin for the goal of perfect anastomosis for operations of middle-low rectal cancer. The da Vinci single port SP system is a brand-new platform with its special design, making surgical suture in narrow space feasible. From June 2024 to October 2024, all three male patients with average body-mass index of 22.1 kg/m2 were successfully operated with pure Robotic single incision total mesorectal excision (TME) with rectal stump transabdominal purse string and single stapled anastomosis technique (SST) . The surgical technique considerations, short-term outcomes were reviewed. There is no conversion case. The average robot docking time was 3 min (range, 3-5 min). The average operative time was 403 min (range 4 hours20mins to 8 hours 20mins), and the estimated blood loss was 10 mL (range, 10 mL). There were no postoperative complications. The patients were put on oral diet average 2.6 days after surgery, bowel movements average 3.3 days and discharged on 8±4 days post operatively. The final pathology revealed the mean 6.6 cm middle- low located rectal cancer with average 3 lymph nodes detected. All the circumferential and distal resection margin were all clear. Pure Robotic single incision (TME) with (SST) for middle- low rectal cancer is technically achievable with acceptable short-term outcomes. This approach not only allows for precise resection of rectum with adequate distal margins under direct visualization, but also reduces the need for expensive stapling system and solve the problem of Da Vinci new SP platform short of its own stapling device. The pathological and short-term clinical outcomes are acceptable. The long-term results still require further careful investigation.