Introduction: Robotic colorectal surgery is expanding across the NHS, but rapid adoption risks variability without structured training and clear reporting. We evaluated short-term outcomes from two UK units after service implementation by fellowship-trained surgeons using a standardised, modular technique. Methods: This was a retrospective, multicentre observational study of consecutive adults undergoing robotic-assisted colorectal resection at two NHS trusts (April 2022 to July 2025). Two consultant colorectal surgeons, each having completed a modular robotic fellowship, performed all operations. Demographics, procedure type, conversion, operating time, length of stay (LOS), 30-day return to theatre, 90-day mortality, Clavien-Dindo (CD) complications and margin status were recorded. Anastomotic leak was predefined as leak requiring intervention (CD≥3). Data are presented as median (IQR) or n (%); no comparative testing was planned. Results: This study included 184 patients, mostly with malignant disease (177/184, 96.2%). Median age was 70 years (IQR 60-76) and median BMI 27 (IQR 24-31). Operations covered right- and left-sided colonic and rectal resections; 80/184 (43%) were for rectal cancer. There were no conversions to laparoscopy or open surgery. Median operating time was 231 minutes (IQR 173–350) and median length of stay 5 days (IQR 4-8). Eleven patients (6%) returned to theatre within 30 days and there were no 90-day mortalities. Overall postoperative morbidity was low, with Clavien-Dindo grade 1-2 complications in 44 patients (24%), grade 3 in 12 (7%), and grade 4 in 1 (1%). For malignant cases, R0 resection was achieved in 175/177 (98.9%). Across all anastomoses (n=151), clinically significant leaks occurred in 4/151 (2.6%), all in the rectal cancer subgroup (4/55, 7.3%); no colonic leaks were observed. Two additional asymptomatic radiological leaks (2/151, 1.3%) resolved without intervention. Discussion: A standardised modular approach delivered high-quality, low-complication outcomes with zero conversions, short stays, low re-operation and leak rates, and high R0 margins. These real-world data show safe, reproducible early performance with low service burden, support wider roll-out of structured robotic training, and provide credible inputs for future cost-effectiveness analyses. Prospective research should now include learning-curve metrics and extend follow-up to oncological, functional and patient-reported outcomes.

AIM:The aim of this study was to assess the short-term outcomes of robotic colorectal surgery implemented through a structured, standardized training pathway in five colorectal centres in the United Kingdom. METHOD:A multicentre retrospective observational study was conducted, involving 523 consecutive patients who underwent robotic colorectal resection between 2015 and 2019. All participating centres followed the European Academy of Robotic Colorectal Surgery training pathway. Patient data, including demographics, operative details, postoperative outcomes and pathology results, were collected and analysed. RESULTS:The study included 447 rectal resections and 76 colonic operations. The median age of the patients was 64.7 years, with the majority of patients (70%) being men. The mean body mass index was 27.4 kg/m2, and 89.7% of the patients underwent surgery for malignancy. The overall conversion rate to open surgery was 4.2%. The median length of stay was 6 days and there was no 30-day mortality. The readmission and reoperation rates were 8.8% and 7.3%, respectively. The anastomotic leak rate was 4.1% for rectal resections and 3.9% for colonic resections. Pathological examination showed a positive circumferential resection margin rate of 2.6%. CONCLUSION:Through the implementation of a structured, standardized training pathway, the participating colorectal centres in the UK achieved safe and effective robotic colorectal surgery pathways with favourable short-term oncological and clinical outcomes. Further studies examining long-term and functional outcomes are needed to assess the broader impact of robotic surgery in colorectal procedures.

Purpose Laparoscopic ileal pouch-anal anastomosis (IPAA) surgery offers improved short-term outcomes over open surgery but can be technically challenging. Robotic surgery has been increasingly used for IPAA surgery, but there is limited evidence supporting its use. This study aims to compare the short-term outcomes of laparoscopic and robotic IPAA procedures. Methods All consecutive patients receiving laparoscopic and robotic IPAA surgery at 3 centres, from 3 countries, between 2008 and 2019 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for gender, previous abdominal surgery, ASA grade (I, II vs III, IV) and procedure performed (proctocolectomy vs completion proctectomy). Their short-term outcomes were examined. Results A total of 89 patients were identified (73 laparoscopic, 16 robotic). The 16 patients that received robotic surgery were matched with 15 laparoscopic patients. Baseline characteristics were similar between the two groups. There were no statistically significant differences in any of the investigated short-term outcomes. Length of stay trend was higher for laparoscopic surgery (9 vs 7 days, p = 0.072) Conclusion Robotic IPAA surgery is safe and feasible and offers similar short-term outcomes to laparoscopic surgery. Length of stay may be lower for robotic IPAA surgery, but further larger scale studies are required in order to demonstrate this.

Background: The quality of care of patients receiving colorectal resections has conventionally relied on individual metrics. When discussing with patients what these outcomes mean, they often find them confusing or overwhelming. Textbook oncological outcome (TOO) is a composite measure that summarises all the ‘desirable’ or ‘ideal’ postoperative clinical and oncological outcomes from both a patient’s and doctor’s point of view. This study aims to evaluate the incidence of TOO in patients receiving robotic colorectal cancer surgery in five robotic colorectal units and understand the risk factors associated with failure to achieve a TOO in these patients. Methods: We present a retrospective, multicentric study with data from a prospectively collected database. All consecutive patients receiving robotic colorectal cancer resections from five centres between 2013 and 2022 were included. Patient characteristics and short-term clinical and oncological data were collected. A TOO was achieved when all components were realized—no conversion to open, no complication with a Clavien–Dindo (CD) ≥ 3, length of hospital stay ≤ 14, no 30-day readmission, no 30-day mortality, and R0 resection. The main outcome measure was a composite measure of “ideal” practice called textbook oncological outcomes. Results: A total of 501 patients submitted to robotic colorectal cancer resection were included. Of the 501 patients included, 388 (77.4%) achieved a TOO. Four patients were converted to open (0.8%); 55 (11%) had LOS > 14 days; 46 (9.2%) had a CD ≥ 3 complication; 30-day readmission rate was 6% (30); 30-day mortality was 0.2% (1); and 480 (95.8%) had an R0 resection. Abdominoperineal resection was a risk factor for not achieving a TOO. Conclusions: Robotic colorectal cancer surgery in robotic centres achieves a high TOO rate. Abdominoperineal resection is a risk factor for failure to achieve a TOO. This measure may be used in future audits and to inform patients clearly on success of treatment.

Purpose: Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer.Methods: Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study.Results: A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant.Conclusion: This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.

Purpose: This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality. Methods: Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 mini-mally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height. Results: Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P = 0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P = 0.445), reoperation in 8 vs. 7 (P = 0.789), clinical anastomotic leak was found in 3 vs. 2 (P = 0.670), and 30-day mortality rates was 2 vs. 1 (P > 0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P = 0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resec-tion between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P = 0.284). Conclusion: This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

Background: Enhanced or accelerating recovery programs have significantly reduced hospital length stay after elective colorectal interventions. Our work aims at reporting an initial experience with ambulatory laparoscopic colectomy (ALC) to assess the criteria of discharge and outcomes. Methods: Between 2006 and 2016, data regarding patients having benefited from elective laparoscopic colorectal resections in two main centres in the United Kingdom have been analysed. Both benign and malignant pathologies were included. A standardised enhanced recovery program was performed for each patient, except epidural analgesia was replaced with single shot spinal infiltration. Patients were followed up through a telephone call system by a nurse. Short-term clinical outcomes were analysed. Results: A total of 833 patients were included and 51 (6.1%) were discharged within 24 h following surgery. Of these, 4 out of 51 (7.8%) patients came back hospital within 30 days of discharge; 2 (3.9%) required reoperation (Small bowel obstruction and wound abscess drainage). Conclusions: This study highlights that a 24-h discharge following elective laparoscopic colorectal interventions seems safe and feasible in selected patients. Although challenging to achieve, a standardised approach to laparoscopic surgery in combination with strict adherence to an enhanced recovery protocol are the fundamental elements of this path.

Background Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery—EARCS). Methods Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. Results Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. Conclusions Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.

The original version of this article, unfortunately, contained an error. The given names and family names of the authors were interchanged and are now presented correctly. The original article has been corrected.].

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

It is now well recognised that neoadjuvant chemoradiotherapy for locally advanced rectal cancer is occasionally associated with a complete clinical response [1]. Not surprisingly many now advocate a "wait and watch" policy for these patients [2] with careful surveillance. Unfortunately around 30% of these patients may have regrowth of tumour which will require surgical intervention [3]. The use of robotic techniques for cancer resections are becoming more frequent particularly in narrow spaces as in the obese male pelvis. Robotic surgery permitsan improved 3-dimensional view, more angulation of the instruments and exclusion of tremors [4,5], which in turn leads to better dissection and preservation of hypogastric nerves [6-8]. This article is protected by copyright. All rights reserved.

Introduction: Robotic systems are designed to address the limitations of laparoscopic surgery, leading to a growing interest in robotic rectal surgery. However, certain technical limitations associated with the previous systems (da Vinci S & Si) have arguably slowed down its wholesale adoption. The latest robotic platform, the da Vinci Xi, addresses these limitations. This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems. Materials and methods: All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases. The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed. Results: A total of 240 patients were identified (124 Si, 116 Xi). Median operation-time and length-of-stay were 260 minutes and 6 days respectively. Conversion and 30-day mortality rates were 0. The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group (230 vs 300 min, p = 0.000) but length-of-stay, lymph node yield and circumferential resection margin favoured the Xi group (7 vs 5 days, p = 0.010; 17 vs 21, p = 0.000; 92.7% vs 99.1%, p = 0.020). Conclusion: Single-docking fully-robotic rectal cancer surgery is safe, feasible and can lead to good short-term outcomes, making it a good alternative to laparoscopic rectal cancer surgery. The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion. Keywords: Robotic surgery, Rectal cancer surgery, da Vinci Xi, da Vinci Si

As obesity becomes more prevalent, it presents a technical challenge for minimally invasive colorectal resection surgery. Various studies have examined the clinical outcomes of obese surgical patients. However, morbidly obese patients (BMI ≥ 35) are becoming increasingly more common. This study aims to investigate the short-term surgical outcomes of morbidly obese patients undergoing minimal-invasive colorectal surgery and compare them with both obese (30 ≤ BMI < 35) and non-obese patients (BMI < 30).

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

A structured training programme is essential for the safe adoption of robotic rectal cancer surgery. The aim of this study is to describe the training pathway and short-term surgical outcomes of three surgeons in two centres (UK and Portugal) undertaking single-docking robotic rectal surgery with the da Vinci Xi and integrated table motion (ITM).

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.