Alexander Rossi, Yuqing Huang, Ira L Leeds
The surgical management of rectal cancer has evolved from open resection to laparoscopic and, more recently, robotic minimally invasive approaches. Laparoscopy established the short-term benefits of minimally invasive rectal surgery but is limited within the confines of the bony pelvis, prompting adoption of the robotic platform with its three-dimensional visualization, wristed instruments, and tremor filtration. Whether these refinements translate into measurable clinical benefit remains debated. This narrative review compares the two approaches across oncologic, perioperative, functional, and economic domains. Pathologic outcomes are broadly equivalent, though contemporary evidence-most notably the REAL trial-suggests a possible emerging robotic advantage, although further study is necessary in this regard. Robotic surgery offers potential advantages in conversion rates, blood loss, and postoperative urinary and sexual function, while laparoscopy retains advantages in operative time and cost. At present, platform choice should be guided by patient anatomy, tumor characteristics, and surgical expertise, with robotic surgery likely most valuable in anatomically challenging cases where laparoscopy is most limited.