Although technically challenging, robotic abdominoperineal resection (APR) with robotic harvest of the rectus abdominus muscular flap can eliminate the need for a midline laparotomy, reduce wound infection rates, lead to faster recovery and less narcotic use, and lower the risk for incisional hernia in patients undergoing surgery for recurrent rectal cancer. This video profiles a recent case at the Medical University of South Carolina (MUSC) performed by Virgilio V. George, M.D., Section Head of Colorectal Surgery, colorectal surgeon Pinckney J. Maxwell, M.D., and plastic surgeon Kevin O. Delaney, M.D. Surgical resident Gabriel R. Chedister, M.D., narrates endoscopic and other footage from the case, including surgical photographs showing trocar placement for both the APR and the robotic flap harvest.