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Robotic surgery in acute colorectal emergencies: a comprehensive systematic review and meta-analysis
Danilo Coco1,1, Silvana Leanza2
1Department of General Surgery, Giglio Hospital Foundation, Cefalu', Italy. webcostruction@msn.com.
Background:
Acute colorectal emergencies, including bowel obstruction, perforation, and ischemia, require rapid surgical intervention and are associated with significant morbidity and mortality. While robotic surgery has demonstrated clear benefits in elective colorectal procedures, its application in emergency scenarios remains limited and under-investigated. This systematic review and meta-analysis aim to assess the safety and effectiveness of robotic surgery compared to conventional laparoscopic and open approaches in the management of acute colorectal emergencies.
Methods:
We performed a comprehensive literature search across Cochrane, PubMed, Embase, and Scopus databases from inception through December 2024, following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs), cohort studies, and case-control studies comparing robotic surgery with traditional techniques in acute colorectal emergencies. Primary outcomes were operative time, conversion to open surgery, and complication rates. Secondary outcomes included mortality, reoperation rates, and hospital length of stay. A random-effects model was applied to account for study heterogeneity.
Results:
Fifteen studies encompassing 2,340 patients (1,170 robotic, 1,170 conventional) were included. Robotic procedures were associated with longer operative times (mean difference [MD] 48.7 min; 95% CI 32.1-65.3; p < 0.001), but demonstrated significantly lower conversion rates to open surgery (odds ratio [OR] 0.42; 95% CI 0.26-0.68; p = 0.001) and reduced overall complication rates (OR 0.61; 95% CI 0.45-0.83; p = 0.002). No significant differences were found for mortality (OR 0.91; 95% CI 0.58-1.42; p = 0.67), reoperation rates (OR 0.78; 95% CI 0.51-1.19; p = 0.25), or length of hospital stay (MD -0.3 days; 95% CI -0.9 to 0.3; p = 0.31).
Conclusion:
Robotic surgery in acute colorectal emergencies appears to reduce conversion and complication rates compared to conventional approaches, despite increased operative times. These findings support the potential role of robotic techniques in emergency settings. Further high-quality RCTs are needed to validate long-term outcomes and cost-effectiveness.
