Robotic Surgery in Emergency Colorectal Procedures: Analysis of Outcomes and Future Trends

摘要

BACKGROUND: Emergency colorectal surgery traditionally employs open approaches, with limited minimally invasive adoption. While robotic surgery demonstrates benefits in elective procedures, its role in emergency settings remains unclear. This retrospective study evaluated outcomes of robotic versus laparoscopic and open approaches in emergency colorectal procedures and predicted future adoption trends. STUDY DESIGN: We analyzed 83,483 patients from the ACS-NSQIP database (2012-2021) who underwent emergency colorectal surgery: 53,731 open, 26,649 laparoscopic, and 3,103 robotic procedures. Outcomes were examined using multivariable regression, propensity score matching, and g-computation analysis. Classification and Regression Trees (CART) were employed to analyze surgical approach selection factors, while Vector Autoregressive models projected future utilization trends. RESULTS: Robotic surgery demonstrated significantly lower conversion rates to open surgery compared to laparoscopy (7.8% vs 24.2%; adjusted OR 0.32, 95% CI 0.28-0.36), shorter length of stay (IRR 0.67, 95% CI 0.65-0.69), and fewer surgical complications (OR 0.65, 95% CI 0.60-0.72). Robotic utilization increased from 0% to 6.6% (2012-2021), with trends suggesting substantial growth toward 20.2% by 2025. Patient selection favored robotics for stable patients with diverticulitis (68.4%) and cancer without sepsis, while open surgery remained predominant for patients with perforation, severe sepsis, or significant comorbidities. CONCLUSIONS: In selected emergency colorectal procedures, robotic surgery demonstrates superior outcomes versus conventional approaches. These outcomes may be partially influenced by patient selection factors, as robotic cases involved more clinically stable patients. These findings support expanded robotic platform availability for emergency procedures, though careful patient selection remains essential. The projected increase in robotic utilization reflects growing acceptance of this technology, suggesting that its technical advantages may extend to more complex emergency cases than previously considered.