Surgery · Medical Literature
Robotic surgery in colorectal emergencies: a systematic review of current evidence.
Abstract
Although laparoscopy continues to be the predominant minimally invasive approach in most emergency settings, the advantages of robotics, well established in elective surgery, are currently being explored in selected scenarios and specialized centres. A systematic review was conducted using PubMed, Cochrane Library and Scopus databases until January 2025. Primary outcome was safety and feasibility of robotics in emergency colorectal surgery. Secondary endpoints included perioperative and postoperative outcomes. Fifteen articles were included with a total of 46 robotic emergency colorectal surgical procedures. Most were performed in a tertiary centre with a da Vinci system. Most common procedures were robotic right hemicolectomy for colon cancer and sigmoid colectomy for acute diverticulitis. Mean operating time for robotic right hemicolectomy was 134 min for benign cases and 241 ± 7 min for malignant cases; robotic sigmoid colectomy showed a mean operating time of 171 ± 3 min. No intraoperative complications were recorded. One case required conversion. Intracorporeal anastomosis was performed in most cases (n = 13). Mean length of stay was 5 days. No Clavien-Dindo grade ≥ 3 complications, reoperation or readmission were reported. Five complete mesocolic excisions (CMEs) were performed. Pathology outcomes were available for four CMEs: showing R0 resection with a mean lymph node harvest of 54 ± 13. In four CMEs, the involved team included an on-call robotic colorectal surgeon and an experience theatre team including experienced anaesthetist in robotic procedures. Robotics in emergency settings is feasible and safe but requires additional training and dedicated teams for optimal outcomes.
Clinical relevance
Is robotic surgery safe and feasible in emergency colorectal surgical settings, and what are the associated perioperative and postoperative outcomes? __SNAPSHOT__ {"studyDesign":"Systematic review (PRISMA-compliant; no meta-analysis performed due to insufficient data homogeneity). Constituent studies comprised predominantly case reports and case series.","setting":"Tertiary referral centres; multinational (database search included PubMed, Cochrane Library, and Scopus through January 2025)","sampleSize":"15 articles included; total of 46 robotic emergency colorectal surgical procedures across all included studies","population":"Adult patients requiring emergency colorectal surgery, including procedures for colon cancer with obstruction and acute diverticulitis requiring sigmoid resection; broader emergency colorectal indications also represented","intervention":"Robotic-assisted emergency colorectal surgery (predominantly using the da Vinci surgical system) including right hemicolectomy and sigmoid colectomy","comparator":"Not applicable — no comparator arm; this is a descriptive systematic review of robotic emergency colorectal procedures without a control group","primaryOutcome":"Safety and feasibility of robotic surgery in the emergency colorectal setting","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
Across 15 included articles encompassing only 46 total procedures, robotic emergency colorectal surgery was found to be technically feasible in highly selected patients at tertiary centres. The most frequently performed procedures were robotic right hemicolectomy for colon cancer and sigmoid colectomy for acute diverticulitis. Mean operating time for robotic right hemicolectomy was 134 min in benign cases and 241 ± 7 min in malignant cases; robotic sigmoid colectomy demonstrated a mean operating time of 171 ± 3 min. No intraoperative complications were recorded across the included cases. One case required conversion (conversion rate: 1/46, approximately 2.2% [calculated]). Intracorporeal anastomosis was completed in 13 of the reported anastomotic cases. No pooled effect sizes, relative risk reductions, absolute risk differences, confidence intervals, p-values, or NNT/NNH values were reported or calculable from abstract-level data. The extremely small aggregate sample size precludes any statistically meaningful comparative inference.
Practice implications
This systematic review establishes that robotic emergency colorectal surgery has been performed with apparent technical feasibility and no recorded intraoperative complications in a small, highly selected series of cases at tertiary centres with established robotic programs. However, it emphatically does not establish that robotic surgery is superior — or even equivalent — to laparoscopic or open emergency colorectal surgery in terms of patient outcomes, complication rates, mortality, or oncologic adequacy, as no comparative control group was included. The patient population is narrowly represented: only 46 procedures from 15 studies (predominantly case reports and case series), performed at specialised tertiary institutions by experienced robotic surgeons under non-randomised, non-controlled conditions. Critically, only abstract-level data were available for this summary, and detailed patient-level outcomes, complication grading (e.g., Clavien-Dindo), length of hospital stay, 30-day mortality, and oncologic outcomes are not reported here. The findings should not be generalised to community hospitals, surgeons without advanced robotic training, or haemodynamically unstable or high-acuity emergency patients. Practice should not change on the basis of this review alone; rather, findings support the cautious, protocol-driven expansion of robotic emergency colorectal surgery in experienced centres, with rigorous prospective data collection. __LIMITATIONS__ Critically small aggregate sample size (n=46 procedures across 15 articles) — vastly underpowered for any safety or efficacy conclusions.,Constituent studies are predominantly case reports and case series — the lowest levels of evidence; high risk of selection, reporting, and publication bias.,No comparator group: no randomised, quasi-randomised, or matched comparison to laparoscopic or open emergency surgery.,Highly selected patient population at tertiary robotic centres with expert surgeons — results are not generalisable to the broader emergency surgical setting.,No pooled statistical analysis, confidence intervals, or risk estimates reported; formal meta-analysis was not performed.,Key postoperative outcomes (mortality, overall morbidity, Clavien-Dindo complications, length of stay, readmission, oncologic outcomes) are not reported in the abstract.,Only abstract-level data were available for this clinical summary — full text analysis may contain additional detail not captured here.,Heterogeneity in included procedures, indications, patient acuity, and surgeon experience limits any cross-study synthesis.,No information on funding source, which limits assessment of potential sponsorship bias.,Absence of follow-up duration data prevents evaluation of medium- or long-term outcomes. __BOTTOM_LINE_CATEGORY__ not_ready_for_clinical_application __BOTTOM_LINE__ This systematic review provides very low-certainty, descriptive evidence that robotic emergency colorectal surgery is technically feasible in highly selected patients at tertiary centres with established robotic programs, with no intraoperative complications recorded across just 46 cases. No comparative efficacy or safety data exist to justify routine adoption over laparoscopy or open surgery in the emergency setting. Clinicians at high-volume robotic centres may cautiously consider robotic approaches in haemodynamically stable, carefully selected emergency colorectal patients, but prospective comparative studies are urgently needed before broader implementation.