Is robotic colorectal surgery worth the cost? An umbrella review integrating clinical outcomes, learning curve, and economic evidence.

Authors

Silvia Martinelli, Alessio Lucarini, Paolo Aurello, Gianfranco Damiani, Niccolo Petrucciani

Published in

Journal of robotic surgery. Volume 20. Issue 1. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Robotic technology has progressively expanded within colorectal surgery owing to its enhanced instrument articulation and superior operative visualization. Despite these technical benefits, its adoption remains constrained by concerns regarding acquisition and procedural costs. Furthermore, the influence of surgeon proficiency and learning-curve progression on economic outcomes has rarely been considered in existing assessments of value. An umbrella review was conducted according to the Joanna Briggs Institute framework and reported in compliance with the PRISMA 2020 statement. A systematic search of PubMed, Embase, Scopus, and the Cochrane Library identified systematic reviews and meta-analyses published from January 2021 through March 2026 evaluating robotic versus laparoscopic colorectal procedures. Review quality was appraised using the AMSTAR 2 tool, while redundancy among included reviews was quantified through the Corrected Covered Area method. Twenty-seven eligible reviews encompassing more than 180 original studies and over 110,000 patients were analyzed. Across the available evidence, robotic colorectal surgery achieved perioperative and oncological outcomes comparable to those reported for laparoscopy, including rates of postoperative complications and anastomotic leakage. A consistent advantage was observed in the reduction of conversion to open surgery, particularly among patients undergoing rectal cancer resection and those with obesity. Although robotic procedures generally required longer operative times, this difference appeared closely linked to the initial phase of surgeon training. Economic analyses demonstrated greater upfront expenditures associated with robotic platforms; nevertheless, evidence from several methodologically robust reviews indicated that these disparities may narrow substantially once institutional and surgeon experience mature, especially in high-volume settings. Robotic colorectal surgery represents a reliable and effective minimally invasive approach that may provide specific technical benefits in challenging operative scenarios. Available cost-effectiveness studies may not fully reflect its long-term economic value, as improvements related to accumulated experience and learning-curve completion are seldom incorporated into current evaluation models.

PMID:
42565915
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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