Background:
Robot-assisted laparoscopic surgery (RALS) for colon cancer has become widely adopted in Japan because of its technical advantages in minimally invasive surgery. However, further refinement aimed at reducing surgical invasiveness is still anticipated. To address this issue, we developed a novel reduced-incision approach using only two incisions, termed dual-incision robot-assisted laparoscopic surgery (D-RALS).

Methods:
D-RALS was performed using the da Vinci Xi system with the two-left technique. A grasping forceps was placed on the fourth robotic arm, and a double-bipolar configuration was used to facilitate stable traction and precise dissection. The remaining surgical steps were performed according to the standard procedure for sigmoid colectomy. Bowel transection was carried out using a robotic stapler introduced through the fourth arm.

Results:
D-RALS was successfully performed in three patients without major intraoperative complications. Operative procedures were completed safely, and adequate oncological resection was achieved while minimizing abdominal incisions.

Conclusion:
D-RALS is a feasible and safe surgical technique. This approach may represent a useful option for selected patients in whom reduction of abdominal incisions is desirable while maintaining oncological adequacy.