Short-term outcomes and learning curve of the double-bipolar method in 100 consecutive robot-assisted colorectal...

The double bipolar method (DBM) using Maryland and fenestrated bipolar forceps has been advocated as a bipolar-centered energy strategy for robotic colorectal surgery; however, evidence beyond small case series is limited. This study therefore evaluated the feasibility, safety, and learning curve of DBM in a consecutive single-institution cohort. We retrospectively analyzed 100 consecutive robotic colorectal resections performed using DBM between June 2023 and September 2025. The primary endpoint was operative time and its learning curve, assessed using the cumulative sum (CUSUM) and segmented regression. Key safety endpoints-anastomotic leakage and major complications (Clavien-Dindo ≥ III)-were summarized descriptively. Secondary endpoints included blood loss, conversion, length of stay, and readmission. Sensitivity analyses employed risk-adjusted CUSUM. The mean operative time was 244 min, and the median blood loss was 3 mL. No cases required conversion to open surgery. Anastomotic leakage and major complications were observed in 0% and 2% of cases, respectively. Overall, vessel sealer use was 53%, declining from 100% (cases 1-49) to 7.8% (cases 50-100). CUSUM and segmented regression identified an inflection at case 49, after which operative efficiency improved without any increase in complications. DBM can be feasibly and safely implemented in robotic colorectal cancer surgery, demonstrating a manageable learning curve, minimal blood loss, and substantially reduced reliance on adjunct sealing devices once proficiency is achieved. These findings support DBM as a feasible, standardized, and potentially cost-aware energy strategy; however, its comparative cost-effectiveness and impact on operative time versus other energy approaches remain uncertain and require dedicated comparative studies. Therefore, multicenter studies evaluating long-term oncologic and economic outcomes are warranted.