Robotic Colorectal Surgery Feasibility in High BMI Patients

Overview

This case series evaluates the feasibility and safety of robotic colorectal surgery in patients with elevated BMI. The study highlights that robotic surgery can be performed with acceptable perioperative morbidity and anaesthetic outcomes in this high-risk population.

Background

Minimally invasive colorectal surgery is the standard of care due to benefits such as reduced pain and faster recovery. However, obesity complicates surgical and anaesthetic management, increasing risks and technical challenges, especially in pelvic procedures. Robotic-assisted surgery offers enhanced visualization and dexterity, potentially overcoming limitations of laparoscopy in obese patients. Despite these advantages, concerns about longer operative times and anaesthetic risks, particularly related to prolonged steep Trendelenburg positioning, have limited widespread adoption.

Data Highlights

Key Findings

• Robotic colorectal surgery is feasible in patients with BMI ≥30 kg/m2, including those with Class II and III obesity.
• Robotic surgery offers technical advantages such as enhanced 3D visualization and improved instrument dexterity, facilitating pelvic dissection in obese patients.
• Perioperative morbidity, including complications and mortality, was acceptable and comparable to other surgical modalities.
• Planned elective critical care admissions and careful anaesthetic management, including attention to Trendelenburg positioning duration, are essential for safety.
• Robotic procedures were performed exclusively by experienced accredited surgeons, ensuring high procedural expertise.
• Use of multimodal analgesia and adherence to enhanced recovery protocols contributed to postoperative management.

Clinical Implications

Robotic colorectal surgery should be considered a viable minimally invasive option for obese patients, potentially improving surgical precision and outcomes in this challenging population. Careful preoperative assessment, anaesthetic planning, and postoperative critical care support are critical to mitigate risks associated with obesity and prolonged Trendelenburg positioning. Surgeon expertise and institutional protocols play key roles in optimizing patient safety and recovery.

Conclusion

Robotic colorectal surgery is a feasible and safe approach for patients with elevated BMI when performed by experienced surgeons within a structured perioperative care framework. This technique may overcome limitations of laparoscopy in obese patients, supporting its broader adoption in this high-risk group.

References

1. World Health Organization 2021 -- Obesity and Overweight Fact Sheet
2. Clavien et al. 2009 -- The Clavien-Dindo Classification of Surgical Complications
3. Institutional Robotic Colorectal Program Data 2019-2024 -- Royal Liverpool Hospital