Robotic systems remain less accessible in emergency settings, particularly during off-hours. Nevertheless, the observed benefits—including lower conversion rates and reduced complications—may support broader adoption and investment in robotic capabilities for emergency surgical care.
Findings
Robotic surgery in emergency colorectal procedures was associated with improved clinical outcomes compared with traditional open or laparoscopic approaches, according to a large analysis of US surgical data. In 83,000 cases over a 10-year period, study researchers found that robotic colectomies had fewer complications, lower conversion rates to open surgery, and shorter hospital stays. Specifically, the conversion rate from minimally invasive to open surgery was significantly lower in robotic procedures (8%) compared with laparoscopic surgery (24%). This finding remained consistent after adjustments using multivariable analysis, propensity score matching, and g-computation models.
Hospital stays were also shorter for robotic cases: Patients who underwent robotic surgery had an adjusted incidence rate ratio (IRR) of 0.67 for length of stay compared with laparoscopic patients. Open surgery was associated with longer stays (IRR = 1.31) and higher complication rates (odds ratio [OR] = 2.04).
Surgical complications occurred less frequently in robotic procedures (odds ratio [OR] = 0.65) compared with laparoscopy. Medical complications followed a similar pattern: patients had lower risk with robotic surgery (OR = 0.79) vs higher risk (OR = 1.62) with open surgery, and fewer robotic cases involved septic shock or advanced disease compared with the open and laparoscopic groups.
Methods
Davide Ferrari, MD, of the Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, and colleagues analyzed data from the American College of Surgeons National Surgical Quality Improvement Program from 2012 to 2021. Of the 83,483 patients included, 64% underwent open surgery, 32% had laparoscopic surgery, and 4% received robotic procedures. Robotic procedures were most often performed in clinically stable patients with conditions such as diverticulitis (68% of robotic cases) or colorectal cancer without sepsis. Open surgery remained predominant in patients with perforation, severe sepsis, or multiple comorbidities. Despite being the least used (7% of emergency colorectal surgeries by 2021), time series modeling predicted that robotic use could rise to 20% by 2025. During the same period, the proportion of open surgeries was projected to decline from 61% to 43%.
“The persistence of significant benefits across multiple analytical methods, including propensity score matching and g-computation, suggests that the technical benefits of the platform persist independently of patient selection factors, and these advantages could possibly extend to a broader range of higher-risk emergency colorectal cases,” wrote the researchers.
Limitations of the study included its retrospective design and lack of data on surgeon experience or institutional infrastructure for robotic surgery. However, the inclusion of more than 3,000 robotic cases provided substantial evidence to evaluate outcomes in this setting.
"Our results provide evidence-based support for health care systems to invest in making robotic platforms accessible for emergency procedures, though successful implementation requires addressing significant challenges."
The authors reported no conflicts of interest.