Introduction Robotic rectal surgery has distinct advantages over laparoscopy. Total robotic resection is coming up after the evolution of hybrid technology. The latest da vinci Xi system (Intuitive Surgical, Sunnyvale, USA) is enabled with newer features to make total robotic resection possible in single docking and single phase. The study aims to assess the advantages of da Vinci Xi system in rectal cancer surgery. It also assesses the initial oncological outcomes after rectal resection with this system from a tertiary cancer centre in India.

Method Twenty three rectal cancer cases were operated from 06/10/2014 to 25/02/2015 robotically. Total robotic technique was used in all patients. The data was evaluated prospectively. The demographic details, body mass index (BMI), perioperative outcomes, pathology results and post-operative complications were noted.

Results 17 cases were given pre-operative chemoradiotherapy as they had clinico-radiologically locally advanced disease (Stage III) at initial evaluation. Other cases was operated upfront. One case needed conversion to open approach as it had invaded presacral fascia. Median age of the cohort was 51 years. Male:Female ratio was 1.55:1. Median BMI was 22. Three patients underwent intersphincteric resection (ISR). Twelve patients underwent anterior resection (AR). Eight patients needed abdominoperineal resection (APR). Median distance from anal verge was 4 cm. Median robotic docking time and robotic procedure time were 8 min and 280 min respectively. Median blood loss was 150 ml. One patient died due to pulmonary thrombo-embolism. Circumferential resection margin (CRM) and longitudinal resection margins (LRM) were uninvolved in all patients. Median distances of tumour from proximal and distal resection margins were 14 cm and 3.5 cm respectively. Median lymph node yield was 12. Median post-operative stay was 6 days.

Conclusion Latest da Vinci Xi system has made total robotic rectal surgery feasible in single docking and single phase. In the wake of new system, four arm total robotic rectal surgery may replace hybrid technique of laparoscopic and robotic surgery for rectal malignancies. The learning curve for the new system appears to be shorter than anticipated. Early perioperative and oncological outcomes of total robotic rectal surgery with the new system are promising.

Disclosure of interest None Declared.