This study aimed to investigate the impact of implant type, cruciate-retaining (CR) vs. posterior-stabilized (PS), on the clinical results of robotic-assisted total knee arthroplasty (RA-TKA) performed with a functional alignment (FA) strategy in varus knee osteoarthritis (KOA). We retrospectively analyzed 221 RA-TKA procedures performed using an FA strategy, including 109 CR and 112 PS implants, with a minimum follow-up period of 18 months (mean: 23.3 months; range: 18-28 months). Patient-reported outcome measures (PROMs) were captured using KOOS-JR, FJS, WOMAC, KSS function, and a 5-point Likert scale. Performance-based outcomes were assessed through the 2-minute walk test (2MWT) and the Timed Up-and-Go test (TUG). Additionally, range of motion (ROM), complications, manipulation under anesthesia (MUA), reoperations, and revisions were evaluated. Functional scores, patient satisfaction with daily or recreational activities, performance-based outcomes, and ROM, showed no significant differences between the CR and PS groups. No complications occurred, and no patients required MUA, reoperations, or revisions in either group. CR and PS implant designs provided comparable functional scores, patient satisfaction, performance-based outcomes, and ROM following functionally aligned RA-TKA for varus KOA. No complications occurred, and no patients required MUA, reoperations, or revisions in either group.

Console time is one of the automated performance metrics (APM) recorded by the robot software during robotic cardiac surgery. Little is known about what this APM predicts in cardiac surgery. This study aimed to evaluate factors associated with console time during robotically assisted mitral valve repair (raMVR). A total of 150 patients underwent raMVR from 7/2021 to 12/2024. Console time and related APMs were extracted from robotic system logs. Correlation analysis, multivariable linear regression, and multivariate analysis of variance (MANOVA) were used to assess associations between console time and pre-, intra-, and post-operative outcomes. Mean console time was 123.2 ± 47.0 min. Console time correlated with body mass index (r = 0.22, p = 0.01), cardiopulmonary bypass (CPB) time (r = 0.50, p < 0.001), aortic cross-clamp (ACC) time (r = 0.60, p < 0.001), and hospital stay (r = 0.24, p = 0.003). Console time was longer with bileaflet prolapse (p = 0.003), annular calcification (p = 0.01), leaflet calcification (p = 0.04), complex repair (p < 0.001), transfusion (p = 0.01) and reoperation for bleeding (p = 0.005). Multivariable regression identified decalcification (B = + 78.6 min, p < 0.001), ACC time (p < 0.001), CPB time (p = 0.02), leaflet resection combined with neochords (p = 0.01), and annular calcification (p = 0.03) as independent predictors. MANOVA showed console time tertiles were significantly associated with postoperative outcomes (Wilks' lambda = 0.86, p = 0.02). Patients in the lowest and middle tertile were more likely to be extubated in the operating room (p < 0.001). Console time reflects procedural complexity and operative intensity in raMVR. As an automated, objective metric, it may serve as a valuable tool for intra-operative assessment, surgical planning, and early outcome prediction in robotic cardiac programs.

Robot-assisted gynecological surgery enhances precision, shortens recovery time, and reduces postoperative complications. However, its impact on patient-reported outcomes and their quality of life remains underexplored. This study evaluates the patient's quality of life following robot-assisted gynecological surgeries, focusing on physical function, pain, vitality, and sexual health. A prospective non-randomized study was conducted, assessing quality of life using validated tools before and at multiple intervals post-surgery using the RAND-36 survey, the Brief Pain Index and the Female Sexual Function Index. Subgroups included patients undergoing robot-assisted hysterectomy, myomectomy, cystectomy or both myomectomy and cystectomy. Significant improvements in quality of life were observed as early as 3 weeks post-surgery, with continued gains at 12 and 24 weeks, where maximum quality of life was achieved. Pain scores decreased from baseline to week 3 and remained consistently low thereafter. Vitality scores returned to baseline within 3 weeks, indicating a faster recovery compared to laparoscopic and traditional open surgeries. Sexual health outcomes initially declined post-surgery but gradually improved over six months. These findings suggest that robot-assisted gynecological surgery enhances long-term quality of life and offers a quicker recovery compared to conventional surgical approaches. However, the non-randomized study design limits the generalizability of the results, underscoring the need for randomized controlled trials to validate these outcomes and further refine patient care strategies.

We sought to characterize the utilization of the dual console (DC) teaching setup for daVinci robotic-assisted anatomic lung resections on a US national level. Intuitive da Vinci robotic system data for thoracic lobectomy and segmentectomy procedures between 2021 and 2022 were included. DC utilization was categorized as never, low, medium or high for surgeons performing 0, < 50%, 50-90% or > 90% of resections with DC activation, respectively. Surgeons and procedure factors associated with DC use was analyzed using binary logistic regression. During the study period, 38,552 lobectomy and 4,955 segmentectomy procedures were performed by 868 unique surgeons. A total of 555 surgeons (63.9%) performed anatomic lung resections using the DC, whereas 313 surgeons (36.1%) never used the DC. Amongst DC users, 176 (31.7%) surgeons were classified as low, 216 (38.9%) as medium and 163 (29.3%) as high utilizers. DC use varied significantly between surgeons based on experience (p = 0.018), with the greatest proportion of high utilizers being surgeons with less than 5 years of experience on the robot. Overall, the DC was used for 42.9% of anatomic lung resection. DC use was higher for segmentectomy than for lobectomy procedures (54.9% vs. 41.4%; p < 0.001). The median console time was 18 min longer with the DC setup (123.9 vs. 105.1 min, p < 0.001). On multivariable analysis, stapler use and Academic or VA/DOD hospital setting were associated with the highest rates of dual console activation. The dual console teaching setup is being used by almost two thirds of surgeons in the US. However, the significant variation of dual console activation indicates a wavering level of participation in teaching amongst surgeons. Further research is needed on robotic trainee involvement and pathways to autonomy for the next generation of thoracic surgeons.

Despite increased surgical experience, improved perioperative care and technological advancements, postoperative ileus (POI) continuous to be a common complication following cystectomy with urinary diversion. In theory, POI can be reduced if lumen of the enteric anastomosis performed during surgery has the sufficient diameter. We aimed to evaluate different stapler types on bowel function recovery, comparing two firings of the robotic Endowrist 45 mm (EW45) stapler with the handheld EndoGia 60 mm (EG60). We hypothesized that better robotic maneuverability and a longer stapler length would create a wider anastomosis and thereby improve postoperative bowel function. This multicentre RCT was conducted between 2018 and 2021 (NCT03385798). Seventy-eight patients with bladder cancer undergoing radical cystectomy with ileal conduit were randomized 1:1 (EW45 or EG60). Time to first flatus and bowel movement was registered postoperatively and patients were followed up with the validated Bowel Function Index (BFI) preoperatively, at 3 weeks, 4 and 12 months postoperatively. The EW45 group had a higher POI rate (24% vs. 3%), longer time to first flatus (93 h vs. 71 h, p = 0.004), and longer length of hospital stay (LOS) (13 vs. 8 days, p = 0.001). No significant differences were observed in readmission, reoperation, or mortality. BFI scores did not differ between groups at any time point. Patients operated with EW45 had higher rates of POI and LOS, indicating worse outcome in the perioperative phase. However, no differences in long-term bowel function were observed and both techniques had the same risk of reoperation and mortality.

This systematic review on novel 3D technologies aims to discuss the current evidence on the usefulness of 3D printing, virtual reality (VR) and augmented reality (AR) simulators in the education and training of young urologists for kidney cancer surgery, highlighting the modalities employed, their educational impact, and areas for future development. We performed a comprehensive literature search limited to the last 10 years across PubMed and Embase libraries, identifying studies evaluating the use of 3D technologies as educational tools in urologist training for kidney cancer surgery. The review followed PRISMA guidelines, and two reviewers independently screened eligible studies. We extracted data on study designs and on urologists' education outcomes, through different subcategories. Seventeen studies were included, mostly small-scale validation or descriptive investigations. Twelve investigated 3D-printed models and five VR/AR platforms. Simulations focused on laparoscopic and robot-assisted partial nephrectomy, often using patient-specific models for rehearsal and skill development. Training outcomes included improved spatial anatomy understanding, increased technical performance, greater procedural confidence, and enhanced familiarity with complex surgical steps. However, considerable heterogeneity in methodology and limited sample sizes across studies underscore the need for standardized evaluation of these educational tools. 3D technologies, including 3D-printed models and VR/AR platforms, show promise in enhancing surgical training for renal cancer by improving anatomical understanding and procedural skills. These technologies demonstrate good precision and can help assess trainee surgical skill. However, evidence remains limited, and further research is needed to validate their effectiveness, cost-efficiency, and integration into standardized urological training curricula.

Minimally invasive neurosurgical procedures are widely popular for the excision of deep-seated brain tumours and skull-base lesions. However, the limited maneuverability of the instruments due to highly confined routes and spaces is a challenge for the neurosurgeons. Even robotic arm-based interventions are difficult to implement as these procedures typically require frequent tool changes. Therefore, a combination of human dexterity and robotic intervention can be a good alternative. Accordingly, we have developed a dedicated, robotically manipulated hand-held instrument prototype that could easily maneuver in confined surgical environments. The manipulator is a continuum-type robot developed by alternate stacking of stiff and flexible discs, actuated by tendon wires attached to a high torque reduction motor. The manipulator mechanics were simulated using Cosserat-rod theory and validated through finite element analysis, physical experiments with calibrated weights. The manipulator was then integrated with a hand-held operating unit and the functionality was tested in a neuro-endo-trainer, followed by functional validation on a human cadaver head. The simplistic design and compact actuation unit of the prototype exhibited ease of fabrication, enhanced maneuverability in confined spaces and a universal appeal to the surgeons. The prototype demonstrated a maximum tip angle of 42.2° under suspended weight of 2.943 N, and successfully supported payloads up to 50 g without structural damage. Functional trials in a neuro-endo-trainer and cadaver confirmed superior maneuverability and access compared to rigid instruments, enabling smooth approach to extended or off-axis skull base regions. As such, the presented manipulator meets key design criteria for a practical, hand-held tool in minimally invasive neurosurgery and serves as a platform for future clinical translation.

Robotic assistance in total knee arthroplasty (TKA) improves surgical precision but may alter intraoperative stress and workload among staff. This study evaluated these effects in 60 robot-assisted procedures involving surgeons, scrub technicians, circulators, and technicians. Preoperative stress was assessed using the STAI-6, intraoperative stress via heart rate, and postoperative workload, satisfaction, confidence, and team interaction through questionnaires. Preoperatively, most staff reported no anxiety, though newly introduced members showed severe anxiety in up to 15% of cases. Intraoperatively, stress patterns varied by role: surgeons peaked during implantation, scrub technicians and circulators during non-robotic phases, and technicians during robotic-specific steps, especially ligament balancing. The robotic arm did not increase surgeon stress but redistributed workload, reducing physical demands for scrub staff and circulators while raising responsibility for technicians. Postoperatively, satisfaction and confidence were high across groups, though scrub technicians reported the greatest workload from added robotic tasks. Robotic systems guided by dedicated professional personnel have the potential to reduce the intraoperative stress level of the whole surgical team, although it adds multiple additional steps to the traditional workflow.

Robot-assisted radical prostatectomy (RARP) has rapidly supplanted conventional laparoscopic radical prostatectomy (LRP), despite the limited high-quality comparative evidence. This systematic review synthesizes randomized controlled trial data comparing RARP with LRP for localized prostate cancer, incorporating the GRADE certainty assessment and pre-planned geographic subgroup analyses. This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420251207193). We conducted a PRISMA-compliant systematic review of MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov through October 2025 for randomized controlled trials comparing RARP with LRP (2D/3D) in men with localized or locally advanced prostate cancer. The primary outcomes were 12-month urinary continence and erectile function scores. Secondary outcomes included perioperative metrics, complications, and positive surgical margins. Random-effects meta-analyses estimated risk ratios (RR) and mean differences (MD) with 95% confidence intervals. The risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using the GRADE methodology. Four randomized controlled trials (1095 participants) met the inclusion criteria, with 734 patients in the RARP group and 361 patients in the LRP group. Conventional LRP achieved significantly superior 12-month urinary continence compared to RARP (RR 1.12, 95% CI 1.03-1.22; p = 0.006; I²=0%; moderate-certainty evidence), equivalent to 66 additional continent patients per 1,000 treated. Erectile function recovery at 12 months significantly favored LRP (RR 1.39, 95% CI 1.09-1.76; p = 0.007; I²=0%; moderate-certainty evidence), representing 91 additional potent patients per 1,000 patients. Positive surgical margins did not differ significantly (RR 1.11, 95% CI 0.85-1.44; p = 0.45; low-certainty evidence), supporting equivalent oncological safety. Perioperative outcomes, including operative time (MD 4.18 min, 95% CI - 0.51 to 8.87; p = 0.08), estimated blood loss (MD - 26.24 mL, 95% CI - 98.68 to 46.21; p = 0.48; I²=91%), and overall complications (RR 0.94, 95% CI 0.52-1.68; p = 0.83) showed no significant differences. The geographic subgroup analysis suggested potential regional variation, but the tests for interaction were not significant. This randomized evidence synthesis demonstrates that conventional laparoscopic radical prostatectomy was associated with significantly better urinary continence and erectile function at 12 months compared with robot-assisted approaches, while maintaining comparable oncologic and perioperative outcomes. These findings suggest that surgeon expertise and institutional experience may be important determinants of patient outcomes, independent of the technology platform employed.

Distal pancreatectomy (DP) remains a technically challenging procedure associated with substantial morbidity. With the advent of robotic surgery, three primary techniques have emerged: robotic classic distal pancreatectomy (RCDP; including splenectomy), the vessel-preserving Kimura technique (KT), and the vessel-sacrificing Warshaw technique (WT). These approaches differ in splenic vessel management, leading to varying perioperative risks and long-term splenic outcomes. We performed a comprehensive meta-analysis comparing these techniques across multiple clinical endpoints. We systematically searched PubMed, Embase, and Cochrane CENTRAL from inception through December 2023, supplemented by manual citation screening. Eligible studies included randomized trials or comparative observational cohorts reporting ≥ 2 techniques with extractable data on operative time, blood loss, or spleen preservation. Data were pooled using random-effects models. Heterogeneity was assessed via I, with subgroup and sensitivity analyses conducted to explore variability. Twenty-two studies (total N ≈ 3,280), including 3 RCTs and 19 retrospective cohorts, met inclusion criteria. RCDP was associated with longer operative times compared with KT (mean difference [MD] 42.3 min, 95% CI 25.1-59.5) and WT (MD 38.7 min, 95% CI 22.4-55.0), but demonstrated reduced intraoperative blood loss versus KT (MD - 85 mL, 95% CI - 120 to - 50) and WT (MD - 78 mL, 95% CI - 110 to - 46). Spleen preservation was highest with KT (98.2%) and WT (96.5%), compared with RCDP (82.1%). No significant differences were observed in clinically relevant postoperative pancreatic fistula (POPF grade B/C), overall complications, or length of hospital stay. RCDP showed lower conversion rates (OR 0.32 vs. KT; OR 0.29 vs. WT). WT was associated with increased late complications, including gastric varices (8.3%) compared with KT (1.2%). Robotic approaches reduced splenic infarction in WT (7.6% robotic vs. 27.5% laparoscopic), and BMI > 28 kg/m, lesion size > 51 mm, and prior abdominal surgery were identified as independent predictors of conversion. RCDP offers superior hemorrhage control and lower conversion risk, but at the cost of reduced spleen preservation and longer operative time. KT and WT provide excellent spleen salvage with comparable short-term safety, though WT carries higher late splenic complication rates. Robotic platforms appear to mitigate some traditional limitations of WT, particularly splenic infarction. However, KT carries a previously underrecognized risk of splenic venous stenosis (41%), potentially leading to left-sided portal hypertension. Technique selection should be individualized based on tumor characteristics, surgical expertise, and patient-specific factors. Future randomized trials should focus on long-term splenic function and cost-effectiveness.

The Single-Port (SP) surgical system represents a significant advancement in robotic surgery, facilitating procedures through a single incision while overcoming the previously reported limitations of single-site surgery. As the first clinic in the German-speaking countries to use the da Vinci SP system for gynecological surgeries to treat benign and malignant diseases, we aim in this study to report our initial experiences and outcomes.

Robotic-Assisted Radical Prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in the United States and over 50% of RARP are performed as ambulatory or same-day discharge encounters. Current literature supports that RARP performed in the outpatient setting are as effective and have no increase in complications compared to those performed inpatient and cost nearly 20% less than those performed inpatient. Between May 2021 and December 2021, two-high volume robotic surgeons at an independent multi-specialty physician group performed RARP in both a freestanding ambulatory surgery center (ASC) and in an affiliated hospital. Data on demographics, clinical and pathological variables, operative metrics, outcomes, and complications were collected. Analysis involved the use of descriptive statistics, t-tests for continuous variables, and Chi-Square analysis and Fisher's tests for categorical variables. 40 ASC cases and 50 hospital cases were identified. There were no significant differences in mean age, BMI, PSA, prostate volume, and final pathological stage between groups. The hospital group had higher grade group classification. There were no significant differences in ASA classification, estimated blood loss, operative time, or complications between groups. The hospital group had higher recovery time and length of stay. There were no readmissions in either group. RARP performed in an ASC demonstrated outcomes comparable to those performed in a hospital. These findings are consistent with published evidence that outpatient RARP are safe and cost-effective, supporting reconsideration of current CMS reimbursement policies that restrict access to ambulatory surgical care for prostate cancer.

As robotic-assisted total knee arthroplasty (TKA) continues to evolve, a key clinical question is whether the learning curve and clinical outcomes differ between CT-dependent and image-independent robotic systems. This retrospective study compared the learning curves and early clinical outcomes of 101 patients undergoing TKA with either a CT-dependent robotic system (Beijing HURWA, Group A) or an image-independent system (Smith & Nephew CORI, Group B). A statistically significant intergroup disparity (P < 0.05) was noted in the rates of transition to conventional treatment, with Group A exhibiting a higher frequency during the learning phase. However, this phase did not witness a significant difference between the groups for other outcomes (p > 0.05). Cumulative sum (CUSUM) analysis was employed to chart the learning curve., peaked at the 15th case for Group A and the 14th for Group B, indicating a similar number of cases to achieve proficiency. During both learning and proficiency phases, the HURWA system demonstrated a shorter bone resection time but longer reference array mounting and registration times. Radiographically, the CT-dependent HURWA system showed superior performance in achieving optimal frontal and lateral femoral component (FFC, LFC) angles. In the early learning phase, Group A reported higher pain scores (VAS) at postoperative day 7, but this difference resolved by day 180. A comparison of the groups demonstrated comparable final knee function (KSS, ROM) and complication rates at all assessment points. The findings indicate that while the two robotic systems exhibit distinct operational time profiles and early radiographic advantages for the CT-dependent system in femoral positioning, both facilitate comparable and satisfactory early clinical outcomes after the initial learning period.

Minimally invasive approaches, including laparoscopic (LARN) and robotic-assisted radical nephrectomy (RARN), have gained adoption over open surgery (ORN) for renal cancer, despite RARN’s higher costs. This contemporary study evaluates trends in RARN, LARN, and ORN use and compares their hospital costs, clinical complications, and mortality rates.

In robot-assisted surgery (RAS), surgical assessment is critical for ensuring competence and achieving optimal surgical outcomes. Artificial intelligence (AI)-based assessment offers an alternative to expert-based assessment but often requires large datasets, which are challenging to obtain. Transfer learning with pretrained algorithms may offer a potential solution and could reduce the need for clinical data. This study explores the use of transfer learning with preclinical porcine data to reduce the clinical data needed for action recognition (AC) and skills assessment (SA) in RAS.

To assess the feasibility of early catheter removal (< 3 days; ECR) after Retzius-sparing robot assisted radical prostatectomy (RS-RARP).

Hepatocellular carcinoma (HCC) is still a leading indication of Surgical resection of a portion of the liver. Laparoscopic and robotic liver resections are some of the techniques that are becoming increasingly common. Although RLR is more dextrous and precise, its benefits over LLR remain controversial because of the variation in the methodology of studies and patient selection. This meta-analysis compared perioperative outcomes between robotic and laparoscopic liver resection in HCC, focusing on operative time, hospital stay, morbidity, mortality, transfusion needs, and bile leak rates. The quality of evidence was assessed using the GRADE approach. A systematic search of PubMed, Scopus, and Cochrane identified 520 records. Five multicenter propensity score-matched cohort studies involving 3,616 patients (Robotic: 3,283; Laparoscopic: 333) met the inclusion criteria. Data on perioperative outcomes were pooled, and the Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the studies. Compared with laparoscopic resection, robotic liver resection had a longer operative time (MD: -35.15 min, 95% CI: -64.90 to - 5.39; p = 0.02; I² = 38%). However, there were no significant differences in blood transfusion rates (RR: 1.50, 95% CI: 0.41-5.47; p = 0.54), bile leaks (RR: 2.11, 95% CI: 0.59-7.52; p = 0.25), hospital stays (MD: -0.19 days, 95% CI: -2.42 to 2.05; p = 0.87; I² = 95%), or conversion to open surgery (RR: 1.22, 95% CI: 0.42-3.59; p = 0.71). RLR showed higher 30-day morbidity (RR: 1.59, 95% CI: 1.04-2.42; p = 0.03), while 90-day mortality did not differ significantly between the two approaches (RR: 4.33, 95% CI: 0.84-22.41; p = 0.08). RLR yields comparable results to LLR in HCC, with no differences in mortality or conversion rates but longer operative times and slightly higher short-term morbidity. Evidence quality was low to very low, emphasizing the need for well-designed randomized trials to inform surgical choices.

To develop, validate, and compare a Traditional Multivariable Logistic Regression model with a Machine Learning-based LASSO Regression Model for predicting significant renal function recovery in adult patients undergoing surgical repair for ureteric obstruction, and to present the most practical model as a clinical nomogram.

Robotic-assisted surgery (RAS) emerged as a transformative approach in various surgical disciplines, particularly in adult cardiothoracic procedures, where it has demonstrated significant benefits such as enhanced precision, improved visualisation, and reduced complication rates. Despite its success in adult surgeries, including mitral valve repairs and coronary artery revascularisations, the application of RAS in neonatal cardiothoracic surgery remains largely unexplored. This narrative review synthesises existing evidence, highlighting the potential of RAS to address the unique challenges posed by neonatal cardiothoracic procedures, which require intricate manoeuvrability and precision within confined anatomical spaces. The review also examines the successes of minimally invasive techniques, such as laparoscopic and thoracoscopic surgeries, in paediatric patients, particularly those with congenital heart disease (CHD), demonstrating their safety and efficacy even in high-risk populations. These findings suggest that RAS could offer similar, if not superior, benefits in neonatal cardiothoracic surgeries in future. Significant gaps in the literature, particularly regarding long-term outcomes and the technical challenges of RAS adaptation for neonatal use, underscore the need for further research. Likewise, technological iterations in the currently available systems (including instrument size and curvature, scope definition and haptic feedback) are required to make this concept a reality by meeting the standard of care. This review argues that while RAS holds considerable promise for improving surgical outcomes in neonates, dedicated research is essential to overcome and fully realise its potential. This review not only underscores the current successes of RAS in adult and paediatric surgeries but also sets a foundation for future exploration into its application in neonatal cardiothoracic procedures, advocating for continued innovation and research in this promising field.

Two emerging techniques for mid-low rectal cancer treatment include robotic surgery (RoTME), and transanal total mesorectal excision (taTME). Additionally, using the superior pelvic diaphragm as a landmark helps protect pelvic autonomic nerves and reduces intraoperative risks. This study compares the long-term oncological and functional outcomes of taTME and RoTME in cT3/cT4 patients after neoadjuvant therapy using propensity score matching, while also evaluating the role of the superior pelvic diaphragm as a surgical guide. We retrospectively analyzed patients who underwent proctectomy between February 2017 and May 2019. After applying strict inclusion criteria, propensity score matching was performed. Additionally, we identified and included patients with a difficult pelvis for further analysis. Oncological outcomes were assessed using 3- and 5-year disease-free survival (DFS) and overall survival (OS), visualized with Kaplan-Meier curves. Pelvic nerve preservation was evaluated based on urinary dysfunction, while anal function was measured using the LARS score questionnaire. 75 patients underwent taTME and 203 underwent RoTME. After 1:2 propensity score matching, the groups comprised 75 taTME and 150 RoTME patients. All patients completed 60-month oncological follow-up, with anal function assessed at six months postoperatively. Compared to RoTME, taTME showed a lower anastomotic leak incidence but higher rate of diverting stomas, despite comparable baseline data.No significant differences were observed in intraoperative complications, functional outcomes, or long-term survival. Notably, identifying the superior pelvic diaphragm intraoperatively aided pelvic nerve preservation. Both RoTME and taTME prove feasible for treating cT3/cT4 lower rectal cancer post-nCRT. When performed beyond the learning curve, these techniques represent safe and reliable surgical options.