Robotic surgery shows better outcomes in select emergency colorectal cases, poised for wider use

Editor's Note

Robotic-assisted surgery is proving to be a strong option for emergency colorectal procedures, offering lower complication rates, shorter hospital stays, and fewer conversions to open surgery than conventional approaches. According to a July 23 article from the Journal of the American College of Surgeons, this approach—long established in elective colorectal surgery—is gaining momentum in emergencies, where open surgery has traditionally dominated.

As detailed in the article, researchers from the US, Italy, and Belgium analyzed 83,483 emergency colorectal surgeries performed between 2012 and 2021 using the ACS National Surgical Quality Improvement Program database. Of these, 53,731 were open, 26,649 laparoscopic, and 3,103 robotic. Multivariable regression, propensity score matching, and other statistical tools assessed outcomes and patient selection patterns, while modeling projected future adoption trends.

The outlet reports robotic surgery had a conversion-to-open rate of 7.8%, compared with 24.2% for laparoscopy, and was linked to shorter lengths of stay and fewer surgical complications. Utilization rose from zero in 2012 to 6.6% in 2021, with models predicting adoption could reach 20.2% this year. Patient selection favored robotic approaches for clinically stable cases, particularly diverticulitis (68.4%) and cancer without sepsis, while open surgery remained the choice for patients with perforation, severe sepsis, or major comorbidities.

The authors emphasized while improved outcomes may be partly due to robotic cases involving more stable patients, the data support expanding access to robotic platforms in emergency settings. Wider adoption could be bolstered by the technology’s technical advantages in complex procedures, but challenges remain in ensuring platform availability, surgeon training, and timely case selection in urgent situations.