Establishing a colorectal robotic unit at a tertiary care Irish hospital: early outcomes and challenges

Abstract

Introduction: Minimally invasive Gastrointestinal (laparoscopic) surgery faced considerable resistance in its early development during the last century, especially before its official introduction in 1989, although it finally becomes gold standard approach across specialities, yet it reached a plateau. Robotic surgery in comparison has surged rapidly specially after the introduction of 4th generation robotic platforms like da Vinci X and XI by Intuitive surgical, due to better vision, stable platform and articulated instruments yet there is lack of a standardised training and implementation protocols
Objective:
We studied the feasibility of establishing a robotic colorectal programme as well as its challenges during implementation phase
Methods:
We analysed our Prospectively maintained data base from the start of the programme in June2024 till January 2026, all colorectal resections were included in the study, data included patient's demographic details, ASA grade, indication for surgery, post operative outcomes including bloods loss, length of stay, and complications like anastomotic leak, readmission, reoperation and mortality
Results
Total 53 patients underwent surgery during study period, 63% males, median age of 68 years ,72% were ASA3, out of 41 colorectal resections 31(75%) were cancers, half (51%) right sided resections, 8 resections were due to sigmoid diverticular disease, and two patients underwent total colectomy for refractory ulcerative colitis. Out of 12 general surgical cases, 6 included cholecystectomies
Average console time for bowel resection has been 168 minutes while 67 minutes for general surgery cases in our cohort
Average blood loss of 14 mls in bowel surgery has been recorded, we had one conversion to open for a difficult splenic flexure mobilisation in a high BMI 33 patient, although 5 patients had some morbidity post operative, only one patient had to go back to theatre due to rectal stump blowout
All cancer patients had R0 resection, average length of stay has been 6 days in our bowel resection cohort
Despite comparable console times our total operating time has been longer, and we could only do one bowel resection on a standard day list mostly due to staff working hours and theatre operational policies
Conclusion: colorectal robotic programme is safe and effective yet poses significant challenges in theatre workflow and operational effectiveness due to longer operating times and learning curve