A Descriptive Analysis of a Learning-Curve Cohort: Prospective Study of the First 2 Years of a Newly Established Robotic Colorectal Surgery Program at a Tertiary Care Centre

Abstract

Introduction: The latest robotic platform has made 4-quadrant robotic abdomino-pelvic surgery technically easier. A direct beneficiary of this development is colorectal surgery. Worldwide, there is an increasing uptake of robotic-assisted surgery (RAS) for colorectal conditions including for cancer. Methods: Within a 6-speciality multi-disciplinary robotic surgery service, a colorectal RAS program was established. A 2-consultant team led the program from November 2017 to December 2019. The program was paused at the beginning of the COVID-19 pandemic. All data was captured prospectively in a dedicated database. The 30-day outcome measures of the first 2-years of activity are reported. Results: In the 2-year study period, 65 patients (35-males, 30-females) underwent colorectal RAS. The mean age of patients was 61-years (21 to 86). Forty-four (68%) resections were for cancer and 27 (43%) were total mesorectal excisions. The conversion rate was 12.3% (8 of 65). The median anaesthetic, docking, console, surgery and total times for colorectal robotic procedures was 34 (25 to 44), 5 (3 to 8), 103 (74 to 145), 161 (102 to 249) and 255 (195 to 324) minutes respectively. The median length of hospital stay was 8-days (6 to 12 days). 12%, 7.7% and 1.5% of patients had a complication, an unplanned return to theatre or an unplanned readmission within 30 days with no recorded mortality. Conclusion: The reported 30-day outcomes of a newly established colorectal RAS program confirm its feasibility and safety. Dual consultant team during its implementation facilitated shared experiential learning. Case selection remains critical for the success.