Robotic Surgery in Acute Care: Development of an Educational Pathway and Single-Institution Outcomes

Background Robotic surgery has been adopted across surgical subspecialties, but integration within Acute Care Surgery (ACS) has lagged. Barriers include unpredictable operative timing, competing demands for operating room (OR) resources, variable staffing, and limited access to structure robotic education for practicing acute care surgeons. We hypothesized that implementation of a robotic ACS program would require coordinated educational, operational, and staffing processes rather than reliance on surgeon training alone. Methods This single-institution retrospective cohort study, approved by the Institutional Review Board, evaluated a structured robotic ACS education pathway at a tertiary academic medical center. Program development centered on three components: surgeon training, staff preparedness, and staged case selection. Clinical implementation progressed from scheduled clinic cases to selected emergency department (ED) presentations and, subsequently, later-day and nighttime cases. Following adoption, the first fifty patients undergoing robotic operations between 5/2022 and 12/2024 by ACS service were evaluated to assess feasibility of implementation, and early perioperative outcomes (conversion to open surgery, complications, reoperations, and readmissions). Results Robotic surgery was successfully integrated into the ACS service despite initial barriers, fifty cases were successfully performed without conversions to open surgery, and no intraoperative complications. One patient (2%) required both readmission and reoperation for trapped preperitoneal fat following ventral hernia repair. Case origins include clinic (78%) and ED (22%) presentations and were performed during scheduled and off-hours periods. Discussion A structured, multidisciplinary service-line implementation pathway enables integration of robotic surgery within ACS practice. Institutional leadership engagement, coordinated training, staff preparation, and reliable access allowed safe adoption across varied presentations without compromising outcomes.