Comparative outcomes of laparoscopic and robotic colorectal cancer surgery in the NHS: real-world evidence from sequential adoption of Versius and da Vinci Xi

TL;DR

This study compares laparoscopic and two robotic systems for colorectal cancer surgery in the NHS, finding that the da Vinci Xi system offers shorter hospital stays and better outcomes.

Contribution

The study provides real-world comparative evidence on robotic colorectal cancer surgery outcomes in the NHS, including learning curves and adjusted clinical metrics.

Findings

da Vinci Xi (dV) showed a significantly shorter length of stay compared to laparoscopy and Versius (CMR).

dV had a higher lymph-node yield and a more favorable learning curve for operative time reduction.

Both robotic systems were found to be oncologically equivalent and safe.

Abstract

Multiple robotic systems are now available for colorectal cancer surgery, yet comparative real-world evidence to guide NHS adoption remains limited. This study compared perioperative, oncological, and learning-curve outcomes for laparoscopic, Versius (CMR), and da Vinci Xi (dV) resections. A single-centre evaluation included elective colorectal cancer resections between November 2021 and May 2025 using laparoscopy, CMR or dV. Primary outcomes were length of stay (LOS) and operative time; secondary outcomes included lymph-node yield and Clavien–Dindo ≥ 2 complications. Analyses used non-parametric tests, Bonferroni-adjusted comparisons and multivariable regression. Learning curves were assessed with rolling means, LOWESS and CUSUM. A total of 290 patients were included: laparoscopy (n = 85), CMR (n = 103), and dV (n = 102). Median LOS was 5, 5 and 4 days respectively (p < 0.001) with dV significantly shorter than laparoscopy after adjustment (− 2.33 days; 95% CI − 3.78 to − 0.88). Risk-adjusted analysis of prolonged LOS (> 5 days) showed lower odds with dV versus CMR (OR 0.45, 95% CI 0.23–0.85; p = 0.002), with adjusted probabilities of 22.1% for dV, 37.5% for CMR and 49.0% for laparoscopy. CMR had longer adjusted operative times than laparoscopy (+ 37.2 min; p = 0.001). Lymph-node yield was highest with dV (median 25.5 vs. 22; p = 0.007), confirmed in adjusted analysis (+ 4.0 nodes; p = 0.004). Major complications were similar; CMR rectal cases had higher unadjusted rates. Learning curves showed operative time reduction for both robotic systems, with earlier plateauing for dV. Both robotic platforms were safe and oncologically equivalent; however, dV demonstrated shorter LOS, higher lymph node yield, and a more favourable learning curve.

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