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

BACKGROUND:Emergency colorectal surgery traditionally uses open approaches, with limited minimally invasive adoption. Although robotic surgery demonstrates benefits in elective procedures, its role in emergency settings remains unclear. This retrospective study evaluated outcomes of robotic vs laparoscopic and open approaches in emergency colorectal procedures and predicted future adoption trends.STUDY DESIGN:We analyzed 83,483 patients from the American College of Surgeons NSQIP database (2012 to 2021) who underwent emergency colorectal surgery: 53,731 open, 26,649 laparoscopic, and 3,103 robotic procedures. Outcomes were analyzed using multivariable regression, propensity score matching, and g-computation analysis. Classification and Regression Trees were used to analyze surgical approaches to selection factors, whereas vector autoregressive models projected future usage trends.RESULTS:Robotic surgery demonstrated significantly lower conversion rates to open surgery compared with laparoscopy (7.8% vs 24.2%; adjusted odds ratio 0.32, 95% CI 0.28 to 0.36), shorter length of stay (incidence rate ratio 0.67, 95% CI 0.65 to 0.69), and fewer surgical complications (odds ratio 0.65, 95% CI 0.60 to 0.72). Robotic usage increased from 0% to 6.6% (2012 to 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, whereas open surgery remained predominant in patients with perforation, severe sepsis, or significant comorbidities.CONCLUSIONS:In selected emergency colorectal procedures, robotic surgery demonstrates superior outcomes vs conventional approaches. These outcomes may be partially influenced by patient selection factors because robotic cases involved more clinically stable patients. These findings support expanded robotic platform availability for emergency procedures, although careful patient selection remains essential. The projected increase in robotic usage reflects a growing acceptance of this technology, suggesting that its technical advantages can extend to more complex emergency cases than previously considered.