Applicability and results of the versius surgical robotic system in colorectal surgery: a systematic review of the literature

Minimally invasive surgery has become the standard of care in colorectal surgery. However, the laparoscopic approach still presents technical challenges, especially when performing intracorporeal anastomosis or total mesorectal excision. Current literature underscores the potential of robotic-assisted surgery in overcoming these challenges. Among emerging robotic platforms, the Versius Surgical Robotic System, shows promises. However, its relatively recent introduction means there is a lack of data on its performances in colorectal surgery. This systematic review aimed to evaluate the current evidence on the use of Versius Surgical Robotic System in colorectal surgery. Following PRISMA 2020 guidelines, MEDLINE, CENTRAL, and EMBASE were systematically searched for original studies reporting on the use of the Versius Surgical Robotic System for colorectal surgery. Out of 199 publications screened, nine studies met the inclusion criteria for qualitative analysis. Most included studies were observational and monocentric studies, with the only large-scale, multicentric prospective data derived from the Versius surgical registry. A total of 561 colorectal procedures were reported, including oncological and benign disease, comprising 159 right hemicolectomies, 37 left colon or sigmoid resection, 253 low anterior resection and 64 abdominoperineal resections. The proportion of conversion to open surgery was 7.0% in the largest series and severe complications, defined as Clavien-Dindo grade 3 or higher was reported in 5.3% of cases. For right hemicolectomies, the mean operative time ranged from 160 to 221 min, with no conversion to open surgery reported and only one case requiring surgical revision. Intracorporeal anastomosis was reported in only one case. Regarding low anterior resection, the mean operative time ranged from 214 to 319 min, with a conversion rate to open of 6.9% and an incidence of severe complications of 6.0% in the largest series. Based on available literature there are no major safety concerns for the use of the Versius Surgical Robotic System for colorectal surgery. However, future well-conducted studies are needed to enable quantitative comparisons between different robotic platforms.