# What Do Randomised Trials Reveal About Robotic Surgery? A Critical Appraisal Across Colorectal, Upper Gastrointestinal, Hepato-Pancreaticobiliary, and General Surgical Specialties

## TL;DR

Robotic surgery is safe and effective in some complex procedures but has longer operation times and higher costs compared to traditional methods.

## Contribution

This paper critically appraises randomized trial evidence on robotic surgery across multiple specialties, highlighting its benefits and limitations.

## Key findings

- Robotic surgery is safe and technically feasible with comparable or improved short-term outcomes in complex cases.
- Trials show significantly longer operative times and higher direct costs for robotic procedures.
- There is limited evidence of cost-effectiveness or long-term oncological superiority.

## Abstract

Robotic-assisted surgery has become an established modality across various surgical specialties, offering enhanced visualisation, precision, and ergonomics compared to conventional laparoscopic approaches. This review summarises current evidence from randomised controlled trials evaluating robotic surgery in colorectal, upper gastrointestinal, hepatopancreatobiliary, hernia, bariatric, and breast procedures. The findings consistently show that robotic surgery is safe and technically feasible, with comparable or improved short-term outcomes in select contexts, particularly in anatomically complex cases such as rectal cancer or pancreatic surgery. However, most trials report significantly longer operative times and higher direct costs, with limited demonstration of clear cost-effectiveness or long-term oncological superiority. Consequently, while robotic surgery holds promise for selected indications, its widespread adoption should be guided by ongoing evidence generation and careful consideration of clinical value, patient outcomes, and economic impact.