The second Robotic Colorectal Surgery Symposium (ROCS2021) was hosted earlier this week as a hybrid event live from Ghent, Belgium. It was strange to be attending a conference after such a long time, however, the hybrid nature of the meeting allowed me the opportunity to meet with colleagues, both old and new, exchange ideas and network. The virtual component enabled the organising committee the opportunity to invite international robotic experts to ensure the most up to date and highest quality content was delivered from across the globe to our 600 registered delegates. Here is a round up of our exciting programme and some of my personal highlights!

Our first session on ‘How to start a robotic colorectal program’ echoed three key themes across all our presentations; 1) stepwise progression, 2) standardisation of key steps and 3) team work. My key take home message from this session was that central to a successful robotic colorectal program is the team behind it; team training, empowerment and growth is essential for any robotic program to succeed. Other exciting developments highlighted in this session included using the principles of component-based robotic training to efficiently achieve competence and the presentation of the upcoming ESCP Colorobotica program for novice surgeons.

Robotic surgery has really enhanced peer-to-peer learning, and our second session on ‘Left sided and rectal resection’ provided some invaluable tips and tricks on splenic flexure mobilisation from Dr Anne Dubois and on approaching the difficult male pelvis from Dr Niels Thomassen. The recurring themes from our first session were reinforced, including, employing a standardised approach and breaking steps down into their key component parts to achieve technical perfection. However, its also important to have a Plan B if this doesn’t work and to appropriately evaluate your operative strategy and improvise where necessary.

Both Professor Quentin Denost and Dr John Marks highlighted the evolving nature of robotics for rectal cancer surgery, with Professor Denost highlighting the benefits of combining robotic and transanal approaches for low rectal cancer and Dr John Marks showcasing the merits of the single port robotic operating system both within the pelvis and transanally. These exciting developments will continue to push the boundaries in complex rectal cancer, allowing a greater proportion of patients a minimally invasive platform, coupled with sphincter-preserving approaches.

Our colonic session focused on the growing popularity and use of robotics for right hemicolectomy. The stable robotic platform, enhanced dexterity and ergonomics facilitates intracorporeal anastomosis in this setting, as was beautifully demonstrated by Dr Anke Smits, and is associated with quicker recovery, less pain and reduced post-operative ileus. The ensuing debate on the robotic approaches to CME by Mr Danilo Miskovic (Medial to Lateral) and Dr Paolo Bianchi (Suprapubic bottom-up) demonstrated that there is growing interest in CME as a technique overall and that the robotic approaches are irrelevant, what is most important is that a safe and oncological resection is carried out.

The final and concluding session of ROCS2021 shone the spotlight on the growing arena of ‘benign robotic colorectal surgery‘. This is an area that will continue to evolve as our adoption of robotic colorectal surgery becomes more widespread and is ripe for technical advancements, as demonstrated by Dr Eric Haas’ talk on the NICE procedure. However, the approaches to benign surgery have to be carefully considered as highlighted by Dr Marcos Gomez-Ruiz, whose talk on robotics in IBD surgery demonstrated the balance between robotic surgery and the potential morbidity in this cohort of patients. For me, this session was the most thought-provoking and technically stimulating, highlighting the benefits of robotics in the benign setting, whilst adding caution regarding patient selection, learning curve and clinical outcomes. The consensus from our experts was that benign robotic surgery is something to consider once you’re over your initial robotic learning; it may seem easy, but these can be some of the most challenging cases you may encounter.

I was fortunate enough to attend the inaugural ROCS2020 meeting in February 2020 as a delegate and am incredibly honoured to have transitioned to becoming a course director for ROCS2021 alongside the brilliant Ellen Van Eetvelde and Pieter Pletinckx. I am hugely grateful to Filip Muysoms for the invitation to join the ROCS team and to Intuitive Surgery for all their support in helping us deliver this conference. Please do catch up with all the FREE sessions on demand. I promise you there is something there for everyone! We are just at the start of a very exciting journey in delivering high-quality educational content on robotic colorectal surgery and we hope to come back next year even bigger and better, hopefully, with a live audience.