The aim of this retrospective single-center study is to demonstrate if the selective omission of SFM during anterior rectal resection can reduce the complexity of the operation, without affecting post-operative and oncologic. The authors developed a new 'one-step' setup to perform a low anterior resection with total mesorectal excision and splenic flexure mobilization for rectal cancer using a completely robotic approach. Splenic flexure (SFM) in rectal cancer surgery is a crucial step which may increase the difficulty of the operation. The new da Vinci S HD system offers improved range of motion that allows for easier access to a wider surgical field.

However, difficulties accessing multiple quadrants of the abdomen with the first robotic system led to a rather slow introduction of the da Vinci into the field of abdominal surgery compared with its success with urologic and cardiac procedures. Some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of the robotic da Vinci system, and its use in gastrointestinal procedures is evolving. Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization.

Mobilization of splenic flexture