Optimized ‘Full Right’ Instrument Configuration in Robotic Rectal Surgery With the Da Vinci Xi System: A Prospective Single-Center Experience

Background: Robotic surgery for rectal cancer offers enhanced visualization, instrument articulation, and ergonomic benefits in confined pelvic spaces. However, the effectiveness of robotic procedures depends heavily on trocar positioning and instrument layout. Conventional configurations often require intraoperative instrument swapping or camera repositioning, potentially disrupting workflow and increasing cognitive strain. To address these limitations, we implemented a standardized “full right” instrument configuration using the Da Vinci Xi system to improve ergonomic control and procedural stability. Methods: We conducted a prospective analysis of 22 consecutive patients undergoing robotic rectal resection at a high-volume tertiary center using the full right configuration. All robotic arms and the assistant port were positioned along the patient’s right side, with the camera fixed on Arm 2 throughout the procedure. Operative, perioperative, and pathological outcomes were evaluated. Results: The mean console time was 170 min, and the mean operative time was 192 min. No conversions or intraoperative complications occurred. No instrument collisions were observed. Estimated blood loss was minimal in all cases. The mean hospital stay was 5.2 days. All patients achieved complete (grade 3) mesorectal excision, with a mean lymph node yield of 16.4 and negative margins in every case. No major postoperative complications were reported. Conclusions: The full right configuration for robotic rectal resection is associated with favorable short-term outcomes, improved ergonomic conditions, and stable instrument positioning. This layout supports consistent workflow across all operative phases and may reduce intraoperative cognitive load. Further validation through larger comparative studies is warranted.