Title : Robotic colorectal resections york teaching hospital experience
Abstract:
The colorectal division in a system of seven hospitals, serving a population of 800,000 over 3,400 square miles, completed the shift to a fully robotic surgical service. The workforce is 10,000 strong and the department has 10 colorectal consultants who perform over 250 laparoscopic resections every year, including segmental colectomies, abdominoperineal excisions (APER), Hartmann’s maneuvers, and complex combinations of these procedures.
The robotic service began in May 2022 with the goal of achieving full functionality in two years without breaching FT pathway time obligations. By May 2024, a fully operational robotic service was available with trained surgeons, assistants, and theatre personnel. The service now has four robotic colorectal lists and one robotic urology list worked on each week. They included comprehensive robotic courses, simulation training modules, troubleshooting for the theatre teams, and hands-on surgeon proctoring in the training components. This provided for an efficient and seamless transition.
An audit was performed during the period 2022 to 2024 which reviewed robotic and laparoscopic resections done for the colorectal department in York. This included 409 cases with patients average age being 70.2 years (SD = 10.7) with range being between 28 to 92 years. . Approximately 66.3% of patients had at least one comorbidity .The robotic cohort had a statistically significant incidence of surgical emphysema (p = 0.005) and chest infection/HAP (p = 0.030), which was perhaps a consequence of air seal use, although, 90-day mortality rates are still comparable for robotic and laparoscopic groups. Surgical complications were pulmonary embolism, aspiration pneumonia, ischaemic stoma, intraoperative bleeding, and others. Primary preventive approaches, including enhanced thromboprophylaxis, ICG application, and enhanced recovery measures, were done.
The approach toward robotic surgery was gradual and controlled, making patient transitions easier while ensuring high levels of care was maintained through organization and thorough teaching. This achievement proves that there is scope for more widespread use of robotics in colorectal surgery
