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Evaluation of an established colorectal robotic programme at an NHS district general hospital: audit of outcomes and systematic review of published data

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Abstract

Introduction

Robotic-assisted surgery (RAS) offers potential advantages over traditional surgical approaches. This study aimed to assess outcomes from a district general hospital (DGH) robotic colorectal programme against published data.

Materials and methods

The robotic programme was established following simulator, dry/wet lab training, and proctoring. We performed a case series analysing technical, patient, and oncological outcomes extracted from a prospective database of colorectal RAS cases (2015–2022). A registered systematic review (PROSPERO CRD42022300773; PubMed, Web of Science, EMBASE) of single-centre colorectal series from established robotic centres (n>200 cases) was completed and compared to local data using descriptive summary statistics. Risk of bias assessment was performed using an adapted version of the Cochrane ROBINS-I tool.

Results

Two hundred thirty-two RAS cases were performed including 122 anterior resections, 56 APERs, 19 rectopexies, and 15 Hartmann’s procedures. The median duration was 325 (IQR 265–400) min. Blood loss was < 100 ml in 97% of cases with 2 (0.9%) cases converted to open. Complications (Clavien-Dindo 3–5) occurred in 19 (8%) patients, with 3 (1.3%) deaths in < 30 days. Length of stay was 7 (IQR 5–11) days. In 169 rectal cancer cases, there were 9 (5.3%) cases with a positive circumferential or distal margin and lymph node yield of 17 (IQR 13–24). A systematic review of 1648 abstracts identified 13 studies from established robotic centres, totaling 4930 cases, with technical, patient, and oncological outcomes comparable to our own case series.

Conclusions

Outcomes from our robotic colorectal programme at a UK DGH are comparable with the largest published case series from world-renowned centres. Training and proctoring together with rolling audit must accompany the expansion of robotic surgery to safeguard outcomes.

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Data availability

Extracted data and meta-analysis code available on request

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Authors and Affiliations

  1. Western General Hospital, EH42XU, Edinburgh, UK

    Peter G Vaughan-Shaw

  2. Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK

    Abraham S Joel, Mohamed Farah, Frank Ofoezie, Maren Liane, Saif Choudhary, James T Royle, Stephen Holtham & Golam Farook

  3. Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK

    Deena Harji

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  1. Peter G Vaughan-Shaw
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Peter Vaughan-Shaw, Abraham Joel, and Mohamed Farah. The first draft of the manuscript was written by Peter Vaughan-Shaw, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript

Corresponding author

Correspondence to Golam Farook.

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Ethics approval

This is an observational study. The study was approved as a service evaluation project by the Clinical Governance and Clinical Effectiveness Department and considered exempt from ethical approval. Informed consent was not deemed necessary.

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The authors declare no competing interests.

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Peter G Vaughan-Shaw and Abraham S Joel are joint first authors.

Previous communications: Accepted for poster presentation at ACPGBI 2022

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Vaughan-Shaw, P.G., Joel, A.S., Farah, M. et al. Evaluation of an established colorectal robotic programme at an NHS district general hospital: audit of outcomes and systematic review of published data. Langenbecks Arch Surg 408, 416 (2023). https://doi.org/10.1007/s00423-023-03152-4

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