To explore the curative effect and advantages of the new surgical procedure for low rectal cancer by robotic intraabdominal incision of the lower margin and total mesorectal excision(TME).

3 patients, with an average age of 65.7 years, were treated with robotic laparoscopic radical anal preservation for low rectal cancer in Jiangsu Hospital of Traditional Chinese Medicine from May to Dec. 2020. The clinical data of these patients were reviewed. All the patients were diagnosed with rectal cancer preoperatively, and the lower margin of the tumor was 2.0-3.5 cm from the anal margin, and no anal canal was involved.

The operation of 3 patients was completed successfully, and there was no transfer to laparotomy or increase of operation channel. The average operation time was about 290 min, and the average intraoperative bleeding was about 80 ml. Two hours after the operation, a small amount of fluid diet can be entered after anesthesia awake. All the patients had their catheters removed on the first day after surgery and urinated smoothly without urinary retention. The average postoperative anal exhaust time was about 1.8 days, and the average postoperative hospital stay was 4.8 days. The lower margin and CRM margin of the specimen pathological examination were negative, and the average distance from the lower margin to the tumor was 1.8 cm. The anastomosis healed well by digital anal examination and colonoscopy 3 months after operation. All patients successfully completed stoma closed as planned. The patients had good anal defecation function after operation, and no postoperative complications such as local infection around the anastomotic site, anastomotic bleeding, anastomotic fistula and stenosis occurred.

The technique of cutting off the lower margin under robot′s direct vision in the abdominal cavity is effective for the radical resection of low rectal cancer with anal preserving, which is a beneficial attempt for the operation of low rectal cancer. The clinical results are good, and it is worthy of further study and application.