Robotic emergency general surgery, future or fallacy?: case-matched comparison of operative and clinical outcomes during the adoption phase in a tertiary centre.

AIMS: Robotic surgery continues to expand rapidly in elective settings; however, its role in emergency care is limited to date. This study aims to evaluate the safety and feasibility of the adoption of robotic emergency general surgery (EGS) within a high-volume centre. METHODS: Robotic EGS cases performed between 2020 and 2024 at a large UK university hospital were identified and matched 1:3 to non-robotic cases based on operation type, age, gender, and pathology. Data on demographics, operative details, and operative and clinical outcomes were collected. Groups were compared using appropriate statistical tests. RESULTS: A total of 369 patients were included, with 95 (25.7%) in the robotic and 274 (74.3%) in the non-robotic (open/laparoscopic) EGS group. There were no differences between groups for demographics, procedures, or pathology. No statistically significant differences were observed in major complications (10.5% vs 9.1%, p = 0.688), conversion to open surgery (1.1% vs 3.9%, p = 0.174), post-operative length of stay (4 vs 3 days, p = 0.814), and 6-month mortality (0.0% vs 2.9%, p = 0.092) between robotic and non-robotic groups. Adjusted analyses showed no association between surgical approach and differences in operative time, major complications, or post-operative stay. CONCLUSION: The introduction of robotic emergency general surgery is safe and feasible with comparable short-term clinical outcomes to non-robotic approaches. Further research is needed to explore the impact of an established robotic EGS programme on long-term clinical, patient, and surgeon-reported outcomes.