Robotic surgery in emergency general surgery: an overview of UK practice

Abstract

INTRODUCTION: Laparoscopic surgery (LS) is well established in the United Kingdom (UK), while robotic surgery (RS) is increasingly adopted in elective practice. However, its role in emergency general surgery (EGS) remains undefined. This study provides the first national estimates of RS use in UK EGS, evaluating trends in utilisation, outcomes, and workforce capacity. METHODS: Two rounds of Freedom of Information (FOI) requests were submitted to all NHS acute trusts and boards providing EGS services across Great Britain, covering 1 January 2019-1 January 2023 and 1 January 2023-1 January 2025. Data collected included robotic system ownership, numbers and types of robotic procedures, length of stay (LOS), complication rates, and staffing. LOS data were reported as mean ± standard deviation, with differences between approaches assessed using Welch's t-tests. RESULTS: Response rates were 83% (113/136 trusts, 2019-2023) and 65% (91/140 trusts, 2023-2025). Robotic availability increased from 36 to 91 systems nationally (147% rise), with the number of trusts performing emergency RS doubling (13 to 26). A total of 1816 emergency robotic procedures were performed in 2023-2025, alongside 9232 elective cases. Cholecystectomy was the most frequent emergency procedure, increasing almost sixfold (200 → 1396). Complications were infrequent, with device-related issues (n = 18) and tissue injury (n = 27) most common. LOS was consistently shorter for RS compared with open surgery across all procedures (all p < 0.01), with particularly marked reductions in cholecystectomy, Hartmann's procedures, and small bowel resections. Comparisons with LS were procedure-specific: RS was shorter in cholecystectomy and hernia repair, equivalent in small bowel resection, and longer in appendectomy. Workforce capacity remained a limiting factor, with median in-hours trained staff unchanged (11 vs 10), but out-of-hours staff rising from 3 to 24 across all trusts. CONCLUSION: Robotic surgery in UK emergency general surgery is feasible, safe, and expanding, though utilisation continues to lag behind elective practice. RS offers clear LOS advantages over open surgery, with variable benefits compared to laparoscopy. Scaling adoption will require addressing cost, system heterogeneity, and the shortage of trained out-of-hours staff. National policy must prioritise training, standardised data collection, and equitable access to ensure safe integration of RS into routine emergency care.