Robotic rectal resection shows a higher rate of primary postoperative ileus (POI) compared to laparoscopic surgery.

• Primary POI occurred in 25.4% of robotic patients versus 8.5% in laparoscopic patients (p=0.007).
• Intraoperative fluid balance was significantly higher in robotic surgery (36.0 vs. 29.2 ml/kg, p=0.0025) along with longer anesthesia time (403 vs. 346 min, p<0.001).

Focus on fluid management and reducing anesthesia time to lower the risk of POI in robotic procedures.

• Risk factors for primary POI include advanced age, male sex, and higher intraoperative fluid balance.