Comparative outcomes of laparoscopic and robotic colorectal cancer surgery in the NHS: real-world evidence from sequential adoption of Versius and da Vinci Xi
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Published version
Author(s)
Type
Journal Article
Abstract
Background 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.
Methods 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.
Results 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.
Conclusion Both robotic platforms were safe and oncologically equivalent; however, dV demonstrated shorter LOS, higher lymph node yield, and a more favourable learning curve.
Methods 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.
Results 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.
Conclusion Both robotic platforms were safe and oncologically equivalent; however, dV demonstrated shorter LOS, higher lymph node yield, and a more favourable learning curve.
Date Issued
2026-02-11
Date Acceptance
2026-01-20
Citation
Journal of Robotic Surgery, 2026, 20 (1)
ISSN
1863-2483
Publisher
Springer
Journal / Book Title
Journal of Robotic Surgery
Volume
20
Issue
1
Copyright Statement
© Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/
License URL
Identifier
10.1007/s11701-026-03186-y
Subjects
Colorectal surgery
Laparoscopic surgery
Robotic-assisted surgery
Training
Learning curves
Publication Status
Published
Article Number
240
Date Publish Online
2026-02-11