Enhancing Surgical Efficiency and Cost‐Effectiveness With <scp>TaTME</scp> ‐Combined Robot‐Assisted Surgery for Lower Rectal Cancer

ABSTRACT Background Robot‐assisted rectal surgery (RAS) offers improved dexterity and visualization; however, the high cost of equipment and consumables remains a major challenge for hospital management. At our institution, we have adopted a combined approach using transanal total mesorectal excision (TaTME) for lower rectal cancers, aiming to shorten operative time and enable two procedures per day to improve cost‐efficiency. Methods This retrospective cohort study included 112 patients who underwent RAS for rectal cancer between 2019 and 2024, excluding those requiring lateral lymph node dissection. Patients were divided into a robotic‐only group (Ra/RS tumors, n = 75) and a TaTME‐combined group (Rb tumors, n = 37). Surgical outcomes and institutional profitability per case were compared, including the number of cases performed twice daily. Results Despite much lower tumor height from the anal verge (3 vs. 10 cm, p &lt; 0.001), the TaTME‐combined group showed significantly shorter operative time than the robotic‐only group (235 vs. 317 min, p &lt; 0.001). Two‐case‐per‐day robotic operations were achieved in 73.0% of the TaTME‐combined group (27 patients) compared to only 20% in the robotic‐only group (15 patients). Oncological outcomes and complication rates were comparable between the groups. In the TaTME‐combined group, performing two procedures per day resulted in a greater gross profit per case (JPY 321 800/case) compared to performing one conventional robotic LAR per day (JPY 224 300/case). Conclusions TaTME‐combined RAS for lower rectal cancer enables efficient surgical scheduling and improved cost‐effectiveness while maintaining oncological safety. This strategy holds promise as a model for economically sustainable rectal cancer care.