Robotic-assisted colorectal surgery increases the adherence to enhanced recovery concepts

The implementation of enhanced recovery concepts (ERC) has been shown to improve postoperative patients' outcomes. One key aspect of ERCs is the minimally invasive approach to the surgical field. To date, data showing potential advantages of robotic-assisted over laparoscopic surgery within ERCs are scarce.

All patients receiving minimally invasive colorectal surgery between January 2021 and February 2023 at the University Hospital Würzburg, Germany were prospectively included and divided into two groups according to the type of surgery being performed (laparoscopic versus robotic-assisted). The primary outcome was adherence to the ERC protocol. Secondary endpoints were postoperative complications, length of hospital stay and the rate of readmission within a follow-up of 30 days postoperatively.

164 patients were included, of which 48.8% (n = 80) received laparoscopic and 51.2% (n = 84) robotic-assisted surgery. Operating times were longer in the robotic-assisted cohort, but the conversion rate as well as the postoperative complication rate and blood loss were comparable in both groups. The overall adherence to the ERC protocol was higher in the robotic-assisted cohort compared to the laparoscopic surgery cohort (80.4% vs. 65.2%, p = 0.005). Patients' full autonomy was reached earlier in patients after robotic-assisted surgery (4 vs. 5 days, p = 0.048). Furthermore, systemic inflammation parameters were lower in patients after robotic-assisted surgery.

Robotic-assisted surgery may improve adherence to ERCs and could reduce postoperative systemic inflammation, potentially contributing to faster postoperative recovery compared with the laparoscopic approach.