Response to Comment on 'Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach'.

We would like to thank our colleagues Zhang et al for their interest in our manuscript on short term outcomes after robotic and laparoscopic rectal cancer surgery. Our study did not consider a potential learning effect due to the inclusion of consecutive, unselected procedures. However, we believe this may not be a pertinent factor for several reasons. First, all participating surgeons at our institution disposed of a longstanding experience in laparoscopic surgery and underwent intensive and structured training before implementing and systematically applying the robotic modality. Second, due to the long institutional tradition of minimally invasive surgery incorporating a dedicated, structured teaching environment, the learning curve may be significantly shorter than the suggested numbers, similar to reports from independent institutions. Furthermore, results from the ROLARR trial, which has been criticized for the large variety of robotic expertise among participating surgeons, were questioned by an analysis based on the learning effect adjustment, reviewing the trial results in favor of robotic surgery. We believe that reporting on a real-life situation of a quaternary care center rather than on highly selected patients better reflects challenges and outcomes related to the adoption of robotic technology. Robotics as cutting-edge technology