The role of RObotic surgery in EMergency setting (ROEM): protocol for a multicentre, observational, prospective international study on the use of robotic platform in emergency surgery
Authors: Milone Marco , Anoldo Pietro , de’Angelis Nicola , Coccolini Federico , Khan Jim , Kluger Yoram , Sartelli Massimo , Ansaloni Luca , Morelli Luca , Zanini Nicola , Vallicelli Carlo , Vigutto Gabriele , Moore Ernest E. , Biffl Walter , Catena Fausto ,   ROEM Collaborative Group, Manigrasso Michele , D’Amore Anna , Pakula Andrea , Garzali Ibrahim Umar , Mulita Francesk , Amit Gupta , Walędziak Maciej , Ruurda Jelle P , Caycedo-Marulanda Antonio , Mangram Alicia , Ioannidis Argyrios L , Jiao Long R , González Carolina , Vaishnav Dhaivat , Shamim Adeel Ahmed , Mallat Ali F , Rossi Stefano , Ietto Giuseppe , Cianci Pasquale , Pantalone Desire , Zaghi Claudia , Monsellato Igor , Garulli Gianluca , D’Andrea Vito , Gasparrini Marcello , Piccoli Micaela , Offi Maria Fortuna , Memeo Riccardo , Coratti Andrea , Giuliani Giuseppe , Formisano Giampaolo , Bianchi Paolo Pietro , Ielpo Benedetto , Giuliani Antonio , Perkins Louis , Scheiterle Maximilian , Coletta Pietro , Muttillo Irnerio , Draus Jerzy , Andreuccetti Jacopo , Verras Georgios-Ioannis , Wiłkojć Michał , van Hillegersberg Richard , Sanchez Alexis , Konstantinidis Konstantinos , Ausania Fabio , Picardi Biagio , Conversano Ivana , Maltinti Gherardo , Costantini Giulia , Portinari Mattia , Bellini Maria Irene , Cosmi Federica , Esposito Sofia , Filippo Rosalinda , Vistoli Fabio , Zawadzki Maricn , Broome Barbara J , Konstantinidis Michael , Puccioni Caterina , Restini Enrico , Di Bella Anna Maria , Palini Gianmarco , Costanzo Maria Ludovica , Gasparrini Matteo , Francescato Alice , Delvecchio Antonella , Mullineris Barbara , Lapolla Pierfrancesco , Mingoli Andrea , Brachini Gioia , Guadagni Simone , Matarazzo Francesco 
Published: June 2024

Abstract
Background
Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety.

Methods
The ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres.

Discussion
Current literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs.