High-quality evidence for laparoscopic colectomy used to treat resectable stages 1–3 colon cancer has demonstrated substantial quality of life (QOL) without any worsening of oncologic outcomes. But evidence for the safety and efficiency of either laparoscopically or robotically assisted low anterior resection is scarce [1]. Minimally invasive surgery, either laparoscopic or robotic, improves QOL. But beyond this, is there any probability of improving also recurrence-free, overall survival and even projecting a cure? Hellan et al. [2] in a recent issue of Surgical Endoscopy reported on the second generation of robotic surgery. However, multiple challenges need to be overcome. Can robotic surgery replace open surgery in the treatment of gastric cancer? What are the challenges, benefits, and risks for patients, surgeons, society, public and private insurance, and public health? These are crucial questions considering the dramatic increase of cancer by 55% projected for 2020. Interest in robotic surgery using the Da Vinci system has exploded over the past few years. This is delineated by the rapidly growing number of patients with gastrointestinal and other solid tumors who are treated by robotically assisted resection [3, 4]. It is of fundamental importance for the scientific community to use evidence-based tools when moving from a current standard surgical treatment practice to a novel experimental new-technology-based surgery. Most recent extensive genetic studies have shown the high complexity and diversity of solid cancers including gastrointestinal cancers [5–9]. This fact urgently suggests the need for new design and development of targeted agents and biomarkers for more effective treatment of solid cancers [10–18]. Therefore, it is surgically naive to believe that switching from open to closed surgery can alter oncologic outcomes. But particularly for rectal cancer, such a probability cannot be excluded. The Da Vinci system may allow a better locoregional control than open low anterior resection for the following reasons. To begin with, the Da Vinci system may ensure a more accurate and precise anatomic total mesorectal excision (TME). Indeed, due to its anatomic location in the pelvis, a precise TME appears in most cases of open surgery to be unfeasible. The second-generation da Vinci System model, as reported by Hellan et al. [2], offers smaller profile instrument arms with increased length and greater range of motion intracorporeally, thus enabling multiquadrant access to the abdominal cavity. This technological improvement was one reason for developing a ‘‘one-step’’ surgical setup for robotic rectal resections requiring mobilization of the splenic flexure. What benefits are realized in the precision of TME? The advantages include local recurrence rate reduction and perhaps avoidance of unnecessary radiotherapy and its adverse effects when the mesorectum has been completely removed. Furthermore, this anatomic structure-based surgery, preventing nerves of vital organ functionality, substantially improves QOL. Hellan et al. [2] noted that robotic technology is especially suitable for dissection in confined spaces such as the E. Hanisch Klinik fur Allgemein-,Viszeralund Endokrine Chirurgie, Asklepios Klinik Langen, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universitat, Frankfurt, Germany