Single-center experience with robotic colorectal surgery for benign indications

Robotic colorectal surgery is established for malignant indications, but evidence supporting its use in benign disease remains limited. We describe perioperative outcomes of 403 consecutive robotic colorectal resections across all indications at a single UK NHS center, with primary focus on safety across benign indications.

Retrospective analysis of a prospectively maintained database (February 2020-November 2025). Cases were stratified by indication: malignant or highly suspected malignancy (n = 332, 82.4%) and benign (n = 71, 17.6%). Benign cases were subclassified into diverticular disease (n = 39), ulcerative colitis (n = 14), Crohn's disease (n = 13), and other (n = 5). Primary outcomes were operative time, length of stay, and Clavien-Dindo complication grade.

Benign patients were younger (median 53 vs. 68 years; p < 0.001) with higher rates of prior abdominal surgery (33.8% vs 19.6%; p = 0.012). Across all 403 cases, median operative time was 240 min (IQR 199-302), median LOS 5 days (IQR 4-8), and CD Grade III-IV rate 9.2%. Despite equivalent operative times (p = 0.84), benign cases converted more frequently (15.5% vs 6.9%; p = 0.031), independently predicted by age (OR 1.04; p = 0.013), and cancer indication (OR 0.31; p = 0.012). Within the benign cohort, IBD patients were younger than those with diverticular disease (p < 0.001). Procedure type and stoma rates differed significantly by subgroup (both p < 0.001), yet complication rates, operative time, and LOS were equivalent.

Robotic colorectal surgery is safe and reproducible across malignant and benign indications within specialised colorectal robotic centers. Complication profiles matched published benchmarks. Benign cases had a higher conversion rate, but this was driven by prior surgical burden and operative complexity, not platform limitation, and it did not increase morbidity. These data constitute the largest single-center UK evidence base for robotic colorectal surgery across all indications and support the expansion of robotic commissioning into benign practice.