Surgery is undergoing a huge transformation, with minimally invasive techniques revolutionizing the surgical clinic. 10 years ago it was uncertain whether laparoscopic techniques could be widely used in the colorectal field, but today the doubts and debates have long subsided, and not only is laparoscopy developing rapidly, but robotic surgical systems are also starting to enter the field of colorectal surgery; the traditional concept of surgery is quietly changing. Robotic surgical systems were originally developed to enable remote surgery, so they must have flexible robotic arms that can replace the human hand and can be controlled remotely, and must have clear and realistic anatomical images that can be transmitted thousands of miles away. The main robot currently used is the Da Vinci Robotic Surgery System, which was approved by the FDA in 2000 and entered the medical market, and has been installed and put into use in China for more than a dozen units. Da Vinci is an extension and sublimation of traditional laparoscopic technology and a breakthrough in the field of laparoscopic surgery. Today’s Da Vinci consists of a console and 4 robotic arms. Firstly, the laparoscope it uses has dual cameras and dual light sources, which can independently collect synchronized video signals and output to the binoculars of the console after computer processing to form an enlarged 3D vision, which cannot be bin by the traditional laparoscope; secondly, the tops of its 3 operating arms simulate human wrists, with forward, backward, left, right, forward rotation, backward rotation and ring rotation Secondly, its three operating arms, the top of which simulates the human wrist, have the functions of forward, backward, left, right, forward, backward and circular rotation, and can also be rotated clockwise or counterclockwise, also known as Endowrist, which is more flexible than the human hand and can provide better results than the human hand and traditional laparoscope in narrow and complicated environments. The operating table is a joystick type, where the surgeon sits comfortably in front of the table, manipulates the lever with both hands, and the hand movements are proportionally transferred to the tip of the robotic arm to complete the surgical operation. During surgery, the robot’s stored surgical videos can be accessed at any time, enabling remote consultation and even remote assistance in surgery. Da Vinci has already played an important role in many surgical fields such as cardiothoracic surgery, hepatobiliary surgery, urology, obstetrics and gynecology, etc. . In the field of minimally invasive prostate and hysterectomy, where it is difficult to perform conventional laparoscopic resection and anastomosis in the narrow pelvic cavity, robotic surgery has been shown to have significant advantages [1-3]. However, the pace of robotic entry into the field of colorectal surgery has been slow and there are fewer relevant reports, probably for the following important reasons: (i) the need to move between multiple abdominal regions during colorectal surgery, which is currently more difficult to achieve with Da Vinci; (ii) the slender robotic arm cannot hold large and small intestines well during surgery; and (iii) there are no cutting closures/anastomoses that can be used by robots. Taking rectal cancer surgery as an example, comprehensive current literature, there are about two types of robotic surgery. i. Hybrid method: i.e., combined application of robotic and traditional laparoscopic techniques, such as freeing the colon (including descending colon and splenic flexure) using traditional laparoscopic techniques, and robotic rectal TME [4] [p]; ii. Full robotic method: this method is further divided into two-step method and three-step method according to the number of times of moving the robotic platform during the operation, i.e., moving the robot for the next abdominal area after the operation is completed, and there are also operators The one-step method is used, in which the robot is not moved during the operation, but the position of the robotic arm is swapped to accommodate the operation in different abdominal regions. The first procedure is exemplified by Hellan M’s team, who in 2007 reported evaluating the regression of 39 consecutive, non-elective primary rectal cancer patients (22 with low anterior resection, 11 with internal sphincter resection, and 6 with transabdominal perineal resection) who underwent robotic-assisted laparoscopic resection [4]. The splenic flexure, descending colon and sigmoid colon were freed laparoscopically, followed by TME using da Vinci. for low anterior resection, the specimen was excised through a 4 cm incision and end-to-end anastomosis was performed using a circumferential anastomosis. For very low tumors, the specimen was excised through the anus and a colonic anastomosis was performed by hand suturing. For transabdominal perineal resection, the specimen was excised through a perineal wound and a sigmoid resection was performed. There were no deaths, the complication rate was 12.8%, and the conversion rate was 2.6% (1/39). The median operative time was 285 minutes, and patients were discharged on postoperative day 4 (range 2 ~ 22 days). All margins were negative and the median number of lymph nodes removed was 13. Zimmern A’s team has performed 47 low and ultra-low rectal radical resections with this method since August 2005. The second procedure is more respected due to the one-step approach. The procedure is performed in two stages, the first dealing with the submesenteric vessels and completing the freeing of the sigmoid colon to the splenic flexure (right lower abdominal unipolar bending scissors, right upper abdominal Maryland bipolar grasping forceps, left upper abdominal Cardiere grasping forceps); this stage initially starts with a total abdominal exploration by laparoscopic techniques and placing the small bowel collaterals in the right upper abdomen to fully expose the surgical field, and then starts with the application of a robotic arm to dissect the submesenteric vessels and protecting the inferior abdominal plexus, freeing the descending colon and splenic flexure. In the second stage of pelvic operation TME; the right upper abdomen and left upper abdomen robotic arms are first unloaded and reassembled in the left upper abdomen and left lower abdomen respectively (left upper abdomen Maryland, left lower abdomen Cardiere), the posterior rectum is identified and preserved from the left side of the rectum, the inferior inferior abdominal plexus and the distal pelvic plexus are identified and preserved, the anal levator is freed, the peritoneum is incised and reflexed to free the anterior rectum, and once the rectum is completely freed, the Once the rectum is completely free, the robot is withdrawn and the remaining steps are still performed by conventional laparoscopic techniques. There are several steps during the procedure that require traction of the intestinal canal, such as traction of the sigmoid colon toward the midline and the transverse colon downward when freeing the colon, traction of the rectum posteriorly and anteriorly when separating the rectum anteriorly, and traction of the rectum posteriorly when separating the rectum anteriorly, some of these steps require the participation of an assistant, so six holes are designed to be made in the patient’s abdomen (four for mounting the robotic arm) so that the assistant can operate with both hands for maximum assistance. The patient’s abdomen is therefore designed with six holes (four for the robotic arm) so that the assistant can operate with both hands for maximum assistance. Recently, Dong Jin Choi et al. described in detail the procedure and short-term outcome of 50 patients with rectal cancer treated with one-step robotic surgery [5]. 40 of the 50 cases were treated with low anterior resection, 8 with intra-sphincter resection coloanal anastomosis, and 2 with abdominal perineal resection; 48 cases were treated with anal preservation, with 16 cases of diversionary ileostomy (8 with anterior resection and 8 with inter-sphincter resection); 6 cases required free splenic flexure The average operating time was 304.8 minutes (1.5 minutes). The average operative time was 304.8 minutes (190C485 minutes). Intraoperative complications occurred in two cases, one in a woman who had received preoperative radiation therapy and had tumor perforation during pelvic dissection, and the other in a woman who had intestinal adhesions and damaged the marginal artery of the middle descending colon during initial laparoscopic dissection of the adhesions, but neither case affected the completion of the procedure. The overall complication rate was 18%. 4 cases of anastomotic leak were successfully controlled by simple drainage; 1 case of anastomotic bleeding was stopped by anoscopic 8-way suture; intra-abdominal bleeding was stopped by itself, but 3u of concentrated red blood cells were transfused; 3 cases developed intestinal obstruction within 4 weeks after surgery and were re-admitted to hospital for conservative treatment to relieve it (2 cases of small bowel obstruction and 1 case of ileostomy outlet obstruction). The indications for robotic techniques are evolving as more and more colorectal surgeons apply them cautiously and continue to discover their advantages and disadvantages. Robotic right hemicolectomy, total/subtotal colectomy, rectal prolapse fixation, and many other procedures for benign and malignant diseases have been performed and have achieved similar results to those of conventional laparoscopy. In conclusion, robotic colorectal surgery is safe and feasible, and it has advantages over traditional laparoscopy in terms of pelvic dissection, freeing splenic flexure, protecting vegetative nerves, and revealing IMA. It is foreseeable that in the near future, with the development and enrichment of related surgical instruments, robotic colorectal surgery will be more popular, but at present, robotic colorectal surgery cannot be performed without the assistance of traditional laparoscopic techniques and instruments. The indications and operations of robotic surgery are not yet standardized. The robot also has its significant disadvantages, such as the loss of pressure and tactile sensation, the surgeon can only see the robot arm clamp the tissue, but can not feel how tight the clamp, but only according to see the 3D image to estimate the clamp pressure; In addition, the price is expensive, an endowrist can only be used 10 times, the cost of consumables for one operation is worth tens of thousands of dollars, and is not covered by health insurance, these factors also greatly limit the These factors also greatly limit the current development of robotics in the field of colorectal surgery.