A modified Delphi consensus on fusion (laparoscopic and robotic) approaches to colorectal surgery in Asia-Pacific

Fusion surgery, where laparoscopic techniques are purposefully integrated into robotic surgery, is a novel approach that can be used in colorectal surgery. However, a standard definition and practical guidance are lacking. Therefore, this study aimed to generate consensus to standardise the definition of fusion surgery and consequently raise awareness of fusion surgical approaches and their appropriate use cases.

We conducted a two-round modified Delphi study with 17 colorectal surgeons from Asia-Pacific (5 Steering Committee [SC]; 12 Expert Panellists [EP]). Statements were drafted by the SC based on clinical experience, published literature and comments from the EP. The EP rated these statements anonymously on a 5-point Likert scale. A virtual expert meeting was held between voting rounds to discuss the statements. Consensus was predefined as ≥ 75% "agree"/"strongly agree" or "disagree"/"strongly disagree".

Ultimately, consensus was reached on 23 statements: "Defining Fusion Surgery in Colorectal Surgery" (n = 2); "When to Consider Fusion Surgery in Colorectal Surgery" (n = 10; 5 statements each on "Device Factors" and "Surgeon Factors"); "Task- or Procedure-Specific Considerations in Colorectal Surgery" (n = 11).

The Expert Panel were aligned on the definition of fusion surgery as a procedure where laparoscopic tools and techniques are electively combined with robotic surgery. Fusion surgery may achieve similar safety and effectiveness as fully robotic surgery, whilst potentially offering advantages such as improved ergonomics, shorter operating times and educational opportunities for bedside assistants. This consensus serves as a valuable guide containing considerations for surgeons to encourage the appropriate adoption of fusion approaches in colorectal surgery.