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Laparoscopic surgery has been proven to have benefits for the patient. To maximize these gains and avoid morbidity, basic surgical principles must be adhered to during laparoscopy. Patient positioning is key not only to avoid postoperative complications but also to allow maximal working space for the surgeon. Surgeons must be familiar with available instruments and their associated advantages and disadvantages to improve ergonomics and efficiency and minimize unnecessary risks.

Laparoscopic abdominoperineal resection (APR) with total mesorectal excision (TME) for low rectal cancer has been shown to be safe and effective and is associated with advantages over open techniques. However, laparoscopy has some limitations secondary to the anatomical structure of pelvis, rigid visualization system, instrument length, and articulation. The da Vinci robot has the potential to overcome some of the limitations of laparoscopy, and early experiences with robotic rectal resection highlight the potential advantages compared to conventional laparoscopy. Robotic APR can be performed utilizing a fully robotic technique or a hybrid laparoscopic–robotic technique whereby the robot is docked after mobilizing the sigmoid colon and dividing the vessels with conventional laparoscopic techniques.