Clinical Scorecard: Integration and execution of robotic-assisted colorectal surgery through a systematic training framework: insights from a specialized referral institution

At a Glance

Key Highlights

• Robotic colorectal surgery overcomes limitations of laparoscopy by enhancing precision, visualization, and ergonomics.
• Structured training program based on European Academy for Robotic Colorectal Surgery (EARCS) model ensures safe adoption and improved patient outcomes.
• Early clinical outcomes from 150 consecutive robotic colorectal cases demonstrate feasibility and safety in a specialized center.

Guideline-Based Recommendations

Diagnosis

• Perform biopsy to confirm colorectal cancer diagnosis.
• Conduct preoperative staging including MRI to assess tumor stage, nodal involvement, and circumferential mesorectal fascia margin.
• Discuss cases in multidisciplinary team (MDT) meetings for treatment planning.

Management

• Offer robotic surgery to patients with rectal cancer and selected sigmoid colon cancers or benign pathology after informed consent.
• Administer neoadjuvant therapy for T4 rectal cancer, node-positive disease, or threatened mesorectal fascia margin (<2 mm) with surgery at 12 weeks post-treatment.
• Use total neoadjuvant treatment (TNT) if extramural venous invasion (EMVI) is present on MRI.
• Employ fourth generation multiport Da Vinci Xi® robotic system for resections.

Monitoring & Follow-up

• Monitor patient outcomes and complications during the learning curve phase.
• Ensure ongoing assessment of surgeon competence through structured training modules and supervised cases.

Risks

• Potential harms and complications associated with the learning curve of robotic colorectal surgery.
• Need for careful patient selection to minimize risks during adoption phase.

Patient & Prescribing Data

150 consecutive patients undergoing robotic colorectal surgery from September 2020 to August 2024

Robotic surgery was offered after informed consent with option to opt for laparoscopic approach; early outcomes indicate safe implementation with structured training.

Clinical Best Practices

• Ensure surgeons have prior laparoscopic colorectal experience before robotic training.
• Adopt a structured training curriculum including theoretical knowledge, online robotic system training, simulator practice, and case observation.
• Complete at least 30 hours of simulation training and fulfill competence scores before hands-on supervised robotic surgery.
• Use expert proctors to supervise initial robotic cases to enhance patient safety and surgeon skill acquisition.

References

• European Academy for Robotic Colorectal Surgery (EARCS)
• Intuitive Da Vinci Learning Curriculum
• ITQAN Simulation Center, Hamad Medical Corporation