Expert consensus on robotic colorectal surgery in Türkiye: A modified Delphi study on indications, techniques, and future perspectives
İbrahim H. Özata1, Arif Emir Narin2, Serkan Sucu3, Defne Yigci2, Emre Bozkurt4, Ahmet Rencuzogullari11Department of General Surgery, Koc University School of Medicine, Istanbul, Türkiye2Koc University School of Medicine, Istanbul, Türkiye
3Department of Abdominal Organ Transplantation, University of Iowa, Iowa City, United States
4Department of Hepatopancreatobiliary System Surgery, Acibadem Altunizade Hospital, Istanbul, Türkiye
INTRODUCTION: Robotic surgery has become a cornerstone of minimally invasive colorectal surgery, offering enhanced visualization, greater dexterity, and improved ergonomics. However, variability in clinical practice and limited guideline coverage for niche areas highlight the need for expert-driven consensus, especially in countries like Türkiye where adoption is expanding but inconsistent.
METHODS: A Modified Delphi process was used to generate expert consensus on key aspects of robotic colorectal surgery. A Scientific Committee of three experienced colorectal surgeons identified four main themes: Indications, education, operating room layout and positioning, and surgical technique and perioperative outcomes. Twenty-one evidence-based statements were developed employing the GRADE framework. These statements were presented and anonymously voted on by participants, predominantly colorectal and general surgeons, during a consensus session at the 17th National Endoscopic Laparoscopic Robotic Surgery Congress in Türkiye (October 2024). A consensus threshold was defined as ≥70% agreement for each statement.
RESULTS: Of the total 21 statements, 15 reached consensuses, including 10 with strong agreement (>90%). Statements related to ergonomic superiority and long-term functional outcomes of robotic surgery received strong support. Topics such as the use of robotic surgery in high BMI patients, prior abdominal surgery, and vessel sealing for IMA showed lower agreement, reflecting a variety in practices and familiarity with robotic techniques. ERAS protocols, although integral to the future of robotic colorectal surgery, received limited support.
DISCUSSION AND CONCLUSION: This study presents a national expert consensus on robotic colorectal surgery in Türkiye. The findings integrate current evidence with expert insight, offering guidance for clinical decision-making and education.
Keywords: Expert consensus, modified delphi method, robotic colorectal surgery
Manuscript Language: English