First Japanese Experience of Robotic-Assisted Low Anterior Resection Using the da Vinci 5: Incorporating Force Feedback and Case Insights in Rectal Cancer Surgery.

INTRODUCTION

Colorectal cancer outcomes depend not only on disease stage but also on surgical quality, particularly in locally advanced rectal cancer. Robot-assisted surgery offers advantages over laparoscopy but lacks haptic feedback. The da Vinci 5 Surgical System introduces Force Feedback (FFB) technology, which transmits kinesthetic sensations to the surgeon and quantifies forces, as well as Case Insights, an artificial intelligence-based intraoperative data platform. To the best of our knowledge, this report describes the first case of robot-assisted low anterior resection for rectal cancer performed in Japan using da Vinci 5.

CASE PRESENTATION: A woman in her 50s presented with constipation and was diagnosed with rectal cancer (cT3N0M0). She underwent robot-assisted low anterior resection using da Vinci 5. Console time was 131 min with minimal blood loss. The patient recovered uneventfully without leakage or urinary dysfunction and was discharged on POD 7. Case Insights revealed an instrument active time of 82% and average FFB forces of 2.1-2.7 N, with forces >6.5 N applied during only 4.3%-6.4% of the procedure, mainly during rectal mobilization. A complete total mesorectal excision and negative circumferential resection margins were achieved.

CONCLUSIONS

Surgical skills have long remained tacit expert knowledge. FFB and Case Insights provide numeric metrics synchronized with intraoperative procedures, which may help convert tacit skills into explicit, quantifiable information. This enables experts to better understand their operative technique and help novices learn through objective, verbalized information that facilitates procedural understanding.