The Role of Standardised Technique in Colorectal Surgery: A 5-Year Comparative Analysis of Robotic vs. Laparoscopic Approaches

Background and Aim: Standardisation is crucial for outcomes in minimally invasive colorectal surgery. Debate continues regarding the comparative efficacy of robotic versus laparoscopic platforms. This study evaluates perioperative outcomes for both approaches, performed by a single surgeon using an identical standardised technique to isolate the platform's effect. Methods: A retrospective cohort study of 250 patients undergoing colorectal resection (2019-2023) was conducted. Patients were divided into laparoscopic (n=121) and robotic (n=129) groups. Data included demographics, ASA grade, conversion rates, operative times, Clavien-Dindo complications, resection margin status (R0/R1), mortality, and length of stay. R software was used for analysis. Results: Demographics were matched, but fewer high-risk (ASA III) patients were in the robotic cohort (38.7% vs. 51.3%; p<0.05). The robotic approach showed a significantly lower conversion rate (0% vs. 6.6%). A non-significant trend toward higher-grade complications existed in the laparoscopic group (median grade II vs. I; p=0.12), with a significantly higher R1 resection rate (n=8 vs. n=2). Laparoscopic 30-day (2 vs. 0) and 90-day (4 vs. 0) mortality was higher. Anastomotic leak rates (1.6% each) and median hospital stay (5 days; p=0.71) were similar in both groups. Conclusion: Using a standardised technique, outcomes are comparable except for a significantly reduced conversion rate with robotics. The observed difference in R1 resection rates may be influenced by baseline differences in patient populations. For skilled surgeons, the choice of platform may be influenced more by economic factors and preference than by major differences in clinical efficacy. What does this paper add to the literature? Debate continues regarding the comparative efficacy of robotic versus laparoscopic platforms. This single-surgeon study compares outcomes in colorectal cancer using minimally invasive procedures and a standardised technique. The result of similar clinical efficacy suggests that standardisation reduces outcome variability and demonstrates that cost and preference may influence platform choices more.