Systematic Assessment of Robotic Technology in Colon and Rectal Surgery

Colorectal Surgery has been on the forefront of adoption of minimally invasive procedures including robotic technology. Use of robotic technology has been shown to decrease rates of conversions that can improve patients outcomes and satisfaction1,2. Despite a lot of enthusiasm, and increasing availability of equipment, real world penetration of this technology has been low3. Multiple factors are contributing, including learning curve for the surgeon and protracted learning curve for the operating room team. Combined with variability of the cases and often need to educate residents and fellows, fewer cases can often be performed in each day when compared to open or laparoscopic cases4. This results in higher cost per procedure and often reluctance of the hospitals to invest further in these technologies5. It was previously thought that surgeons was the main source of inefficiencies and delays, however it is becoming clear from recent publications and our pilot data that multiple factors contribute to this problem including team training and preparedness, understanding of technology and time taken to teach6. Relative contribution of these factors and best way to fix the problem is not known. This requires a systematic analysis of standard operating room processes, team proficiency, technology, skill acquisition, and outcomes.