Implementation of a Robotic Colorectal Surgery Program: Early Outcomes from a Tertiary Referral Center

Background: Robotic-assisted colorectal surgery is increasingly adopted; however, evidence regarding outcomes during the early implementation phase remains limited. This study aimed to evaluate the feasibility and short-term outcomes of a newly established robotic colorectal surgery program at a tertiary referral center. Methods: All consecutive patients undergoing robotic colorectal resection between November 2019 and February 2026 were prospectively recorded and retrospectively analyzed. Perioperative outcomes, conversion rates, postoperative complications, in-hospital mortality, and histopathological results were assessed. Results: A total of 177 patients were included, with a progressive increase in surgical volume over time. Most procedures were performed for oncological indications (159, 90%), while 18 (10%) were performed for benign diseases. The most frequent procedures were right hemicolectomy (45%), left hemicolectomy (32%), and low anterior rectal resection (23%). Mean operative time was 331.1 ± 75.0 min. Conversion to open surgery occurred in 15 patients (8.5%), mainly due to extensive intra-abdominal adhesions, particularly during the early phase of the program. Postoperative complications occurred in 20 patients (11%), while 3 patients (2%) died during hospitalization. Major complications (Clavien-Dindo ≥ III) occurred in 7%, and anastomotic leakage in 3%. Mean hospital stay was 10.1 ± 7.6 days. R0 resection was reported in all cases, with adequate lymph-node retrieval for staging. Conclusions: In this single-center, non-comparative series, robotic colorectal surgery was feasible during program implementation, with acceptable short-term perioperative outcomes. Comparative studies are needed to determine its relative performance compared with laparoscopy.