Objective quantification of rectal transection technique using SureForm™ stapler log data in robotic rectal cancer surgery

Robotic surgical platforms continuously generate digital procedural data that may help assess surgical techniques. However, quantitative analyses of robotic stapler utilization during rectal transection remain limited. This study aimed to characterize rectal transection techniques using SureForm™ stapler log data in robotic rectal cancer surgery. Thirty-two patients who underwent robotic anterior resection for rectal cancer using the da Vinci SureForm™ stapling system between 2022 and 2024 were retrospectively analyzed. Stapler log data, including firing duration, pitch angle, and yaw angle, were extracted and evaluated. Patients were divided into single-firing and multiple-firing groups based on the number of stapler firings required to complete rectal transection. A total of 55 stapler firings were analyzed. The median pitch angle was 46.4° (IQR 35.7–52.8°; range 1.2–59.9°), with most firings performed within 40°–55°. The median yaw angle was 15.8° (IQR 9.5–25.3°; range 0–59.9°), and most firings occurred within 0°–20°. Multiple firings were associated with significantly longer operative times and tended to occur more frequently in patients with lower rectal tumors and diverting stomas. However, no significant differences in pitch or yaw angles were observed between the single- and multiple-firing groups. A representative case requiring four stapler firings involved locally advanced RS cancer with bladder invasion following total neoadjuvant therapy. SureForm™ stapler log data enabled objective characterization of firing duration and stapler orientation during robotic rectal transection. These exploratory measurements provide preliminary reference data for robotic stapler use. Larger multicenter studies are required to determine their clinical relevance.