Transition to total robotic colorectal practice: feasibility and outcomes in a UK colorectal unit

Robotic surgery uptake is increasing rapidly, with the anticipation that most laparoscopic procedures will eventually be performed robotically. Multiple benefits have been demonstrated: reduced conversion rates, stoma rates, complications, post-operative pain and length of stay, and improved primary anastomosis rate, oncological outcomes and gastrointestinal recovery. This study aimed to assess the feasibility and outcomes of a full departmental transition to total robotic colorectal practice, in line with the National Health Service robotic surgery strategic vision. This single-centre retrospective cohort study was performed in a UK centre from 2018 to 2024, including the three-year transition period from laparoscopic to total robotic colorectal practice. The primary outcome was conversion rate. Secondary outcomes were post-operative complications, anastomotic leak, stoma rates, resection margins, lymph node harvest, intra-operative blood loss, post-operative pain, return to theatre and length of stay. 1479 operations were analysed: 584 robotic (39.4%), 807 laparoscopic (54.6%) and 88 open (5.9%). 1085 (73.4%) operations were for colorectal cancer, 394 (26.6%) for benign pathologies. All robotic surgery outcomes were non-inferior to laparoscopy. Statistically significant differences were found in conversion rate (2% vs. 12%, p = 0.001), intra-operative blood loss (p = 0.01), length of stay (4 vs. 5 days, p = 0.001), lymph node harvest (21 vs. 20, p = 0.006), R0 resection rates ( 90% vs. 87%, p = 0.0001) and median PCA volume (38 vs. 67 mls, p = 0.001). Full departmental change to total robotic colorectal practice is achievable in both colorectal cancer and benign disease with an improvement upon laparoscopic outcomes.