Implementation of da Vinci Xi robotic colorectal surgery by fellowship-trained surgeons using a standardised modular technique: a multicentre study from two UK units

Abstract

Introduction: Robotic colorectal surgery is expanding across the NHS, but rapid adoption risks variability without structured training and clear reporting. We evaluated short-term outcomes from two UK units after service implementation by fellowship-trained surgeons using a standardised, modular technique.

Methods: This was a retrospective, multicentre observational study of consecutive adults undergoing robotic-assisted colorectal resection at two NHS trusts (April 2022 to July 2025). Two consultant colorectal surgeons, each having completed a modular robotic fellowship, performed all operations. Demographics, procedure type, conversion, operating time, length of stay (LOS), 30-day return to theatre, 90-day mortality, Clavien-Dindo (CD) complications and margin status were recorded. Anastomotic leak was predefined as leak requiring intervention (CD≥3). Data are presented as median (IQR) or n (%); no comparative testing was planned.

Results: This study included 184 patients, mostly with malignant disease (177/184, 96.2%). Median age was 70 years (IQR 60-76) and median BMI 27 (IQR 24-31). Operations covered right- and left-sided colonic and rectal resections; 80/184 (43%) were for rectal cancer. There were no conversions to laparoscopy or open surgery. Median operating time was 231 minutes (IQR 173–350) and median length of stay 5 days (IQR 4-8). Eleven patients (6%) returned to theatre within 30 days and there were no 90-day mortalities. Overall postoperative morbidity was low, with Clavien-Dindo grade 1-2 complications in 44 patients (24%), grade 3 in 12 (7%), and grade 4 in 1 (1%). For malignant cases, R0 resection was achieved in 175/177 (98.9%). Across all anastomoses (n=151), clinically significant leaks occurred in 4/151 (2.6%), all in the rectal cancer subgroup (4/55, 7.3%); no colonic leaks were observed. Two additional asymptomatic radiological leaks (2/151, 1.3%) resolved without intervention.

Discussion: A standardised modular approach delivered high-quality, low-complication outcomes with zero conversions, short stays, low re-operation and leak rates, and high R0 margins. These real-world data show safe, reproducible early performance with low service burden, support wider roll-out of structured robotic training, and provide credible inputs for future cost-effectiveness analyses. Prospective research should now include learning-curve metrics and extend follow-up to oncological, functional and patient-reported outcomes.