{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T17:50:30Z","timestamp":1791654630270,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Robotics Computer Surgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advanced rectal and anal malignancies often require dissections beyond total mesorectal planes for improved oncological outcomes. While minimally invasive techniques facilitate this approach, they result in larger perineal defects, creating reconstructive challenges. Robotic\u2010assisted surgery enhances precision, visualisation, and ergonomics, potentially optimising outcomes. However, data on robotics beyond total mesorectal excision (bTME) remain limited. This study evaluated robotic bTME and synchronous gracilis or PAP (profunda artery perforator) flap reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series reviewed 10 patients with locally advanced or recurrent anorectal cancer who underwent elective robotic bTME with synchronous perineal gracilis or PAP flap reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median operative time was 465\u00a0minutes. Gracilis flap harvest was concurrent. No major flap\u2010related complications or reoperations. R0 resection was achieved in 80%. At 1\u2010year, local recurrence was 0%, distant metastases 30%, and disease\u2010free survival 70%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Robotics bTME with synchronous gracilis or PAP flap reconstruction is feasible, efficient, and oncologically safe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/rcs.70223","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T17:35:21Z","timestamp":1791653721000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic Beyond Total Mesorectal Excision With Synchronous Perineal Flap Reconstruction: Feasibility and Early Outcomes"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6402-5539","authenticated-orcid":false,"given":"Ahlam H.","family":"Alharbi","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medicine in Rabigh King Abdulaziz University  Rabigh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5737-9558","authenticated-orcid":false,"given":"Muhammad R.","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Mid and South Essex NHS Foundation Trust  Basildon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolly M.","family":"Dowsett","sequence":"additional","affiliation":[{"name":"Sir Thomas Browne Academic Colorectal Unit Norfolk and Norwich University Hospital NHS Foundation Trust  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4092-3534","authenticated-orcid":false,"given":"Eleanor J. M.","family":"Rudge","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospital NHS Foundation Trust  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4685-1935","authenticated-orcid":false,"given":"Hassan I.","family":"Shah","sequence":"additional","affiliation":[{"name":"Sir Thomas Browne Academic Colorectal Unit Norfolk and Norwich University Hospital NHS Foundation Trust  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Kapur","sequence":"additional","affiliation":[{"name":"Sir Thomas Browne Academic Colorectal Unit Norfolk and Norwich University Hospital NHS Foundation Trust  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Haywood","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Norfolk and Norwich University Hospital NHS Foundation Trust  Norwich UK"},{"name":"Department of Anatomy Norwich Medical School, University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anais","family":"Rosich\u2010Medina","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Norfolk and Norwich University Hospital NHS Foundation Trust  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1467-815X","authenticated-orcid":false,"given":"Irshad A.","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102022\u2010327736"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200202000\u201000009"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002528"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16136"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0b013e318155a762"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000003002"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2022.106800"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12446"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10071518"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199201000\u201000009"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2023.11.006"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16710"},{"key":"e_1_2_12_14_1","volume-title":"TNM Classification of Malignant Tumours","author":"Brierley J. 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