Robotic surgery in emergency setting: 2021 WSES position paper.
Creators: name: De'Angelis, Nicola
name: Khan, Jim
name: Marchegiani, Francesco
name: Bianchi, Giorgio
name: Aisoni, Filippo
name: Alberti, Daniele
name: Ansaloni, Luca
name: Biffl, Walter
name: Chiara, Osvaldo
name: Ceccarelli, Graziano
name: Coccolini, Federico
name: Cicuttin, Enrico
name: D'Hondt, Mathieu
name: Di Saverio, Salomone
name: Diana, Michele
name: De Simone, Belinda
name: Espin-Basany, Eloy
name: Fichtner-Feigl, Stefan
name: Kashuk, Jeffry
name: Kouwenhoven, Ewout
name: Leppaniemi, Ari
name: Beghdadi, Nassiba
name: Memeo, Riccardo
name: Milone, Marco
name: Moore, Ernest
name: Peitzmann, Andrew
name: Pessaux, Patrick
name: Pikoulis, Manos
name: Pisano, Michele
name: Ris, Frederic
name: Sartelli, Massimo
name: Spinoglio, Giuseppe
name: Sugrue, Michael
name: Tan, Edward
name: Gavriilidis, Paschalis
name: Weber, Dieter
name: Kluger, Yoram
name: Catena, Fausto
Publisher: name: Apollo - University of Cambridge Repository
Year: 2022
Subjects: Review
Emergency surgery
Robotic surgery
General surgery
Minimally invasive surgery

description: BACKGROUND: Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery. METHODS: This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus. RESULTS: Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. CONCLUSIONS: Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.