EP225 - Safety Of Early Discharge Following Elective Robotic Colorectal Surgery

Purpose/Background: Robotic-assisted colorectal surgery has markedly increased in recent years but evidence on the safety of early discharge following such procedures is limited. This single-center prospective observational study aimed to assess the feasibility and clinical outcomes of very early (within 24 hours) and early (within 72 hours) discharge protocols for patients undergoing elective robotic colorectal surgery, which is the standard approach for colorectal resections at our institution.

Methods/Interventions: The study included consecutive adult patients who underwent elective robotic colorectal surgery between May 2022 and May 2025 and were managed according to Enhanced Recovery After Surgery protocols. Inclusion criteria were: age < 75 years, American Society of Anesthesiologists physical status classification I or II, body mass index < 30, no chronic anticoagulant therapy and residence near the hospital. Patients who experienced significant intraoperative complications (e.g. major bleeding, ostomy formation) were excluded. All procedures were performed using the Da Vinci Xi surgical system. For left-sided resections the splenic flexure was routinely mobilized and the inferior mesenteric artery clipped at its origin. Mesorectal dissection, when indicated, was conducted with preservation of the mesorectal fascia as well as the hypogastric and lateral pelvic nerves. Colorectal anastomoses were fashioned using a double-stapling technique and the anastomosis was reinforced with simple interrupted non-barbed sutures. Right-sided resections were performed with complete mesocolic excision using a pedicle-first approach. An intracorporeal side-to-side ileocolic anastomosis was created in all cases using robotic staplers. The ileal and colonic enterotomies were closed with a two-layer running non-barbed suture. In all cases indocyanine green fluorescence was used to assess anastomotic vascularization. No intra-abdominal drain was placed and the foley catheter was removed before the end of anesthesia. Patients were discharged if fully functional and comfortable with the discharge plan. In the days following discharge a member of the healthcare staff contacted each patient to assess bowel function, diet tolerance, pain control and overall satisfaction.

Results/Outcomes: Of the 327 colorectal procedures performed, 87 patients (26.6%) were included in the protocol and 61% of these were discharged within 72 hours after surgery (17% underwent right colectomy and 54.7% left colectomy). Specifically twelve patients (13.8%) were discharged within 24 hours, twenty-five (28.7%) within 48 hours, and sixteen (18.4%) within 72 hours after surgery. The rate of malignant disease was similar between patients discharged within 24 hours and those discharged within 72 hours (66.6% vs. 65.8%, respectively). The overall 30-day readmission and reoperation rates among patients discharged within 72 hours were low, at 3.8% and 1.9%, respectively. No anastomotic leaks were observed.

Conclusion/Discussion: Very early and early discharge appear to be safe for patients undergoing elective robotic colorectal surgery. The successful implementation of these protocols depends on both the technical advantages of the robotic approach, particularly the ability to reinforce the anastomosis, and on close collaboration among the healthcare team and patients. This new discharge protocol may open new perspectives for postoperative management, providing safe, patient-centered and medically sound alternatives for out-of-hospital care.