Modular Robotic NOSES-II for Mid-Rectal Cancer: A Preliminary Feasibility Study of a Structured Surgical Procedure
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Background and Objectives
Robotic-assisted natural orifice specimen extraction surgery (NOSES) is a minimally invasive approach for mid-rectal cancer, but it is technically complex and lacks a standardized operational framework. This study aimed to propose and preliminarily validate a structured modular robotic NOSES-II surgical procedure for mid-rectal cancer.
Methods
This was a retrospective observational study that consecutively enrolled 11 patients with mid-rectal cancer who underwent modular robotic NOSES-II surgery at our center between December 2024 and August 2025. All procedures were performed by the same surgical team strictly following the predefined six-module structured surgical protocol. Perioperative indicators, pathological outcomes, and patient-reported outcomes (PROs) at 4–8 months postoperatively were collected. Key techniques were analyzed via high-definition surgical videos.
Results
All 11 procedures were completed successfully without conversion to open surgery. The mean operative time was 299.6 ± 54.2 minutes, and the mean intraoperative blood loss was 94.1 ± 50.6 mL. The mean number of harvested lymph nodes was 17.4 ± 8.4, with a 100% R0 resection rate. No severe complications (Clavien-Dindo grade ≥ III) occurred. The mean postoperative hospital stay was 8.2 ± 1.5 days. Postoperative PROs indicated good defecatory function, urinary function, and overall quality of life.
Conclusions
Preliminary findings demonstrate that the structured modular robotic NOSES-II procedure is safe and feasible for the treatment of mid-rectal cancer. This modular protocol provides a clear and reproducible technical framework for this complex procedure, and it is expected to achieve favorable functional preservation while ensuring oncological radicality.
