Background and Aims Complete situs inversus (SIT) is a rare congenital abnormality of organ mirror-image arrangement, presenting certain challenges for abdominal surgical procedures. The Da Vinci robotic system, with its high-definition 3D vision and flexible operation, holds potential for application in patients with anatomical variations. This report presents the diagnosis and treatment process of a patient with rectal mass and SIT who underwent robotic-assisted surgery. Additionally, relevant literature is reviewed to provide insights for individualized surgical strategies in patients with complex anatomical variations and to promote the further clinical application of robotic-assisted surgery systems.Methods A case from the First Affiliated Hospital of Zhengzhou University is reported, in which a patient with rectal mass and SIT successfully underwent lesion resection using the Da Vinci robotic system with an unconventional "five-port" technique. A systematic literature review was also conducted (including 35 case reports), to summarize the surgical characteristics of colorectal procedures in SIT patients and the advantages of robotic system application.Results The patient was a 74-year-old male who presented with rectal bleeding. Imaging confirmed the diagnosis of SIT, and colonoscopy revealed a large polypoid mass with ulceration at the apex, located 13-18 cm from the anal verge. The patient subsequently underwent Da Vinci robotic-assisted resection of the rectal lesion. The robotic system effectively overcame the challenges posed by mirror-image anatomy, enabling complete excision of the lesion. The operation lasted 183 minutes, with intraoperative blood loss of less than 20 mL. Postoperative pathology confirmed a villous tubular adenoma with high-grade intraepithelial neoplasia. The patient had an uneventful recovery, and no recurrence was observed during the 9-month follow-up. Literature analysis demonstrated that the robotic system, through magnified 3D visualization, flexible instrument articulation, and tremor filtration, significantly improves surgical precision in patients with anatomical anomalies.Conclusion The Da Vinci robotic system effectively addresses the challenges of anatomical variations related to SIT in low rectal surgery. Its stability and precision offer a new technical option for tumor resection under complex anatomical conditions, demonstrating clinical value for widespread application.