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Minimally invasive surgery has demonstrated many benefits in general surgery, particularly in colon and rectal procedures. On the other hand, it has some limitations that must be taken into account, especially technical drawback. Robotic surgery has incorporated many improvements to overcome this disadvantage, such as 3D visualization, articulating instruments assisting complex and precise movements. As a result, robotic colorectal surgery shows less intraoperative blood loss, shorter time to oral tolerance and initial flatus (particularly associated with "Enhanced Recovery After Surgery" protocol), less conversion rate to open surgery, shortened hospital stay, and longer distal margins compared to laparoscopic and open surgery. This approach also shows a shorter learning curve. Some studies suggest that it could decrease perioperatively or 30 days after the intervention's mortality, raise overall survival, reduce wound infection, and improve functional results, while others show no significant difference. However, it lengthens surgical time. Otherwise, the studies included do not show statistically significant changes in the number of resected lymph nodes and anastomotic leaks. Economic costs remain one of the major concerns, although to date there are no large‐scale studies that have evaluated this aspect from a global point of view. Robotic surgery represents a qualitative leap in surgical instruments and, although there is no strong evidence in favor of the use of robotic surgery over laparoscopic or open surgery, there is enough evidence to support its use in colorectal surgery, with potential advantages for patients. [ABSTRACT FROM AUTHOR]

A robotic small bowel resection followed by Kono-S anastomosis was offered to the patient. Once we get close to finishing the posterior wall closing, we put in another stay stich that will be another 00 braided suture that is going to allow us to expose the area of the anastomosis that we are suturing at this moment. During the next step we will measure the diameter of the anastomosis, score the small bowel and confirm that the length of the scoring is around 7 cm. Scoring starts 1 cm to the end of the small bowel and finishes 7 cm proximal or distal to the starting point. [Extracted from the article]

I Dear Sir i , Oncological surgery for colon cancer involves resection of the tumour along with the adjacent mesentery and a lymphadenectomy appropriate to the location and stage of the tumour. Since Stages II and III cannot be accurately differentiated preoperatively in colon cancer, resection of the mesentery adjacent to the terminal ileum is important to achieve adequate complete excision of the mesentery [3]. A complete lymphadenectomy following the ileal branch of the superior mesenteric vein in the direction of the ileum can be safely performed, resecting an ileal length of between 10 and 15 cm, because most of peri-ileal lymph node metastases will be found in this area [4]. [Extracted from the article]

Background: This study aimed to evaluate the use of binary metric-based (proficiency-based progression; PBP) performance assessments and global evaluative assessment of robotic skills (GEARS) of a robotic-assisted low anterior rectal resection (RA-LAR) procedure., Method: A prospective study of video analysis of RA-LAR procedures was carried out using the PBP metrics with binary parameters previously developed, and GEARS. Recordings were collected from five novice surgeons (≤30 RA-LAR previously performed) and seven experienced surgeons (>30 RA-LAR previously performed). Two consultant colorectal surgeons were trained to be assessors in the use of PBP binary parameters to evaluate the procedure phases, surgical steps, errors, and critical errors in male and female patients and GEARS scores. Novice and experienced surgeons were categorized and assessed using PBP metrics and GEARS; mean scores obtained were compared for statistical purpose. Also, the inter-rater reliability (IRR) of these assessment tools was evaluated., Results: Twenty unedited recordings of RA-LAR procedures were blindly assessed. Overall, using PBP metric-based assessment, a subgroup of experienced surgeons made more errors (20 versus 16, P = 0.158) and critical errors (9.2 versus 7.8, P = 0.417) than the novice group, although not significantly. However, during the critical phase of RA-LAR, experienced surgeons made significantly fewer errors than the novice group (95% CI of the difference, Lower = 0.104 - Upper = 5.155, df = 11.9, t = 2.23, p = 0.042), and a similar pattern was observed for critical errors. The PBP metric and GEARS assessment tools distinguished between the objectively assessed performance of experienced and novice colorectal surgeons performing RA-LAR (total error scores with PBP metrics, P = 0.019-0.008; GEARS scores, P = 0.029-0.025). GEARS demonstrated poor IRR (mean IRR 0.49) and weaker discrimination between groups (15-41 per cent difference). PBP binary metrics demonstrated good IRR (mean 0.94) and robust discrimination particularly for total error scores (58-64 per cent)., Conclusions: PBP binary metrics seem to be useful for metric-based training for surgeons learning RA-LAR procedures., (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.)