**8. Robotic abdominoperineal resection**

The current indications for abdominoperineal resection are represented by:


There are no notable differences between the execution of the first steps. In general, the mobilization of the splenic flexure should not be performed, because the length of the sigmoid colon is sufficient to create a terminal colostomy. The differences occur in the dissection of the pelvic floor. For abdominoperineal resection, lateral dissection beyond the levator ani muscle is important for a lateral lymphadenectomy until the medial edge of the obturator fascia and down until the level of the ischiorectal fossa. If we compare the laparoscopic and the robotic approach, the superiority of the robot in performing the extra-levator resection is obvious. Robotic assisted sectioning of the levator ani muscle allows a precise dissection of the pelvic floor and shortens the perineal dissection time [39].
