Current evidence and reported experiences for robot-assisted emergency general surgery: systematic review

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Healthcare Technology Assessment

Background:

• Emergency general surgery (EGS) is a significant global health challenge.
• Robot-assisted surgery adoption in EGS has lagged behind elective procedures.
• Growing interest in REGS necessitates a thorough evaluation of its current status.

Purpose of the Study:

• To systematically review the current role, outcomes, costs, and implementation of robot-assisted surgery in EGS.
• To assess the safety, clinical outcomes, and economic implications of REGS.
• To identify strategies for successful REGS implementation.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searched PubMed, EMBASE, and Cochrane Library up to January 2025.
• Included 20 studies (over 5 million patients), assessing safety, outcomes, cost, and experience using the Newcastle-Ottawa Scale.

Main Results:

• Robotic approaches showed low conversion rates, comparable/shorter lengths of stay, and similar/reduced complications versus laparoscopic or open surgery.
• Operative times were generally longer, and hospital costs were consistently higher with robotic use.
• Implementation strategies involved staged training, multidisciplinary teams, and institutional support.

Conclusions:

• Robot-assisted EGS is feasible and safe in select patients with appropriate infrastructure and expertise.
• Encouraging early outcomes are tempered by higher costs and limited high-quality evidence.
• Future prospective studies and cost-effectiveness analyses are crucial for defining the long-term role of robotics in EGS.