Assessment of the Safety and Effectiveness of Colorectal Robotic-Assisted Surgery: the First 50 Consecutive Cases at a Single Centre

Background: Colorectal robotic-assisted-surgery (RAS) is a novel technology with scarce real-world evidence. The aim of this retrospective review was to ascertain the safety and effectiveness of colorectal RAS. Methods: The da Vinci® Xi™ robot system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) was used to perform the first 50 colorectal resections in our centre. Outcomes regarding safety and efficacy were analysed and learning curves (LC) were plotted using RStudio. Results: The median patient age and BMI were 65 years (IQR, 50.25-76.5) and 28.3kg/m2 (IQR, 25.2-30.7), respectively, and 27 patients were female. Malignancy (66%) followed by rectal prolapse (18%) was the most frequent diagnosis, and all malignant tumours were completely resected. High anterior resection was the most frequently performed operation (36%). The median operative time was 256.5 minutes (IQR, 202.2-332.8). Twenty-seven patients had anastomosis (54%), a stoma was formed in 7 (14%) and 7 anastomoses required defunctioning loop ileostomy (14%). Two unexpected intra-operative events occurred, and neither required conversion to an open procedure. Thirty-eight complications occurred in 21 patients, and most were minor by the Clavien-Dindo classification: CD 1 (17, 44.7%) or 2 (11, 28.9%). Moreover, 5 patients developed an anastomotic leak (14.7%), 5 developed infections (10%), 2 required transfusions (4%) and 3 needed re-operation (6%). There was no 30-day mortality and the readmission rate was 8%. The median length of stay in hospital was 6 days (IQR,4-8). All resections, except for low anterior resections, resulted in a significantly longer stay compared to rectopexies. Finally, projections from LCs indicated that outcome optimization can be achieved after experience with 33-39 cases. Conclusions: Colorectal RAS in our centre was both safe and effective. In the initial 50 cases, there was no 30-day mortality and no need for conversion to an open surgery. The readmission and complication (>CD 2) rates were 8% and 20%, respectively.