腹部无辅助切口经自然腔道取标本手术（NOSES）作为王锡山教授带领团队创新的“微创中的微创”手术体系和理念提出和开展以来，已经在结直肠肿瘤根治术以及胸、腹、盆腔多瘤种中得到广泛应用。依托的腹腔镜平台也从最初的2D到3D到如今的达芬奇机器人手术平台逐渐升级。达芬奇机器人手术操作系统以其学习曲线短、手术视野清晰、操作精度高等特点迅速被外科医师关注。然而，应用机器人平台手术与传统开腹手术或腹腔镜等平台手术一样，都客观地存在着其自身的优越性和局限性。笔者将通过总结本团队在低位、中位、高位直肠癌应用机器人开展NOSES-Ⅰ、Ⅱ、Ⅳ式三个代表性经典NOSES直肠癌根治手术的技术特点和技巧，客观评价机器人平台开展NOSES直肠癌根治术的优越性和局限性以及需要关注的关键问题，为在机器人平台开展NOSES手术的团队提供依据，为患者带来更大获益。

As an innovative "minimally invasive" surgical system and concept led by professor Wang Xishan, abdominal non incision natural orifice specimen extraction surgery (NOSES) has been widely used in radical resection of colorectal tumors and multiple tumors of chest, abdomen and pelvis. The laparoscopic platform is also gradually upgraded from the original 2D to 3D to today's Da Vinci robotic surgery platform. The Da Vinci robotic surgical operation system has been paid close attention to by surgeons because of its short learning curve, clear surgical field of vision and high operation accuracy. However, robot platform surgery has its own advantages and limitations as traditional laparotomy or laparoscopy. In this paper, the author will summarize the technical characteristics and skills of the team in the application of robots to carry out the three representative classic NOSES-Ⅰ, Ⅱ and Ⅳ radical resection of rectal cancer in low, medium and high rectal cancer, and objectively evaluate the advantages, limitations and key issues that need to be paid attention to, provide basis for the team carrying out NOSES surgery on the robot platform and bring greater benefits to patients.