{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:03:48Z","timestamp":1784538228985,"version":"3.55.0"},"reference-count":23,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Robotic platforms expand minimally invasive options in colorectal surgery but raise concerns about training and patient safety. Dual-console systems may enable real-time coaching while preserving outcomes. Methods: We implemented a structured framework for safe implementation of robotic colorectal surgery that balances trainee autonomy with patient safety using a dual-console model. Early cases emphasized low-complexity pathology with escalation by predefined benchmarks. We prospectively gathered data and evaluated early program outcomes with primary endpoints including intraoperative adverse events, conversion to open surgery, 30-day morbidity, anastomotic integrity, and oncologic quality metrics. Secondary endpoints included operative time. Results: We included the analysis of 17 patients operated by one surgeon under supervision and compared the results to other senior colorectal surgeons. Out of the 17 patients, there were no conversions or anastomotic leaks. Overall complications were comparable to baseline robotic cases. Resection margins and lymph node yields met oncologic standards. Operative times were longer during early adoption but approached baseline with progression. Operative times were significantly reduced after eight cases and approached the times of senior surgeons after 13 cases. Conclusions: A dual-console strategy enables safe, scalable training in robotic colorectal surgery without compromising short-term patient outcomes or oncologic quality. Key elements include rigorous case selection, proficiency-based progression, real-time coaching, standardized protocols, and continuous data surveillance. This framework can guide institutions seeking to expand robotic colorectal programs while safeguarding patients and accelerating the learning curve.<\/jats:p>","DOI":"10.3390\/jcm15145669","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:54:13Z","timestamp":1784534053000},"page":"5669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safe Implementation of Robotic Colorectal Surgery: Balancing Surgical Training and Patient Safety with the Dual-Console System"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7049-3590","authenticated-orcid":false,"given":"Jurij Ale\u0161","family":"Ko\u0161ir","sequence":"first","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka 7, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1002-4853","authenticated-orcid":false,"given":"Miha","family":"Petri\u010d","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0791-2083","authenticated-orcid":false,"given":"Bla\u017e","family":"Trotov\u0161ek","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8861-3412","authenticated-orcid":false,"given":"Gregor","family":"Nor\u010di\u010d","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9832-4596","authenticated-orcid":false,"given":"Jan","family":"Grosek","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1111\/j.1463-1318.2011.02907.x","article-title":"Robotic resection compared with laparoscopic rectal resection for cancer: Systematic review and meta-analysis of short-term outcome","volume":"14","author":"Trastulli","year":"2012","journal-title":"Colorectal Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1007\/s00464-013-3163-5","article-title":"Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection","volume":"28","author":"Keller","year":"2014","journal-title":"Surg. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/01.sla.0000103020.19595.7d","article-title":"Robotic surgery: A current perspective","volume":"239","author":"Lanfranco","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jayne, D., Pigazzi, A., Marshall, H., Croft, J., Corrigan, N., Copeland, J., Quirke, P., West, N., Edlin, R., and Hulme, C. (2019). Robotic-Assisted Surgery Compared with Laparoscopic Resection for Rectal Cancer: The ROLARR RCT, NIHR Journals Library.","DOI":"10.3310\/eme06100"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/SLA.0000000000000613","article-title":"Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: A comparative study with laparoscopic surgery","volume":"261","author":"Park","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wong, N.W., Teo, N.Z., and Ngu, J.C. (2024). Learning curve for Robotic Colorectal Surgery. Cancers, 16.","DOI":"10.3390\/cancers16193420"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1097\/DCR.0b013e31826ab4dd","article-title":"Learning curve and case selection in laparoscopic colorectal surgery: Systematic review and international multicenter analysis of 4852 cases","volume":"55","author":"Miskovic","year":"2012","journal-title":"Dis. Colon. Rectum."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0002-9610(05)80397-6","article-title":"Complications of laparoscopic cholecystectomy: A national survey of 4292 hospitals and an analysis of 77,604 cases","volume":"165","author":"Deziel","year":"1993","journal-title":"Am. J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jamcollsurg.2006.11.010","article-title":"Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills","volume":"204","author":"Gumbs","year":"2007","journal-title":"J. Am. Coll. Surg."},{"key":"ref_10","first-page":"113","article-title":"Dual-console robotic surgery: A new teaching paradigm","volume":"7","author":"Smith","year":"2012","journal-title":"J. Surg. Educ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1002\/bjs.9135","article-title":"Feasibility of robotic pancreaticoduodenectomy","volume":"100","author":"Boggi","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4174\/astr.2015.89.4.190","article-title":"Robotic versus conventional laparoscopic surgery for rectal cancer: Systematic review and meta-analysis","volume":"89","author":"Lee","year":"2015","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1007\/BF02660768","article-title":"Comparison of robotically performed and traditional laparoscopic colorectal surgery","volume":"46","author":"Delaney","year":"2003","journal-title":"Dis. Colon. Rectum."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/j.1471-0528.2011.03139.x","article-title":"Training and learning robotic surgery, time for a more structured approach: A systematic review","volume":"119","author":"Schreuder","year":"2012","journal-title":"BJOG"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6337","DOI":"10.1007\/s00464-022-09087-z","article-title":"The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: A systematic review","volume":"36","author":"Burghgraef","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00268-012-1772-0","article-title":"Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS\u00ae) Society recommendations","volume":"37","author":"Gustafsson","year":"2013","journal-title":"World J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Trastulli, S., Cirocchi, R., Desiderio, J., Coratti, A., Guarino, S., Renzi, C., Corsi, A., Boselli, C., Santoro, A., and Minelli, L. (2015). Robotic versus laparoscopic approach in colonic resections for cancer and benign diseases: Systematic review and meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0134062"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1089\/lap.2014.0199","article-title":"Robotic right colectomy with intracorporeal anastomosis: Experience with 52 consecutive cases","volume":"25","author":"Lujan","year":"2015","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Proietti, F., Flammia, R.S., Licari, L.C., Bologna, E., Anceschi, U., Ferriero, M.C., Tuderti, G., Mastroianni, R., Brassetti, A., and Simone, G. (2024). Simulation and Training in Robot-Assisted Urological Surgery: From Model to Patient. J. Clin. Med., 13.","DOI":"10.3390\/jcm13061590"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4111\/icu.2016.57.2.75","article-title":"Past, present and future of urological robotic surgery","volume":"57","author":"Jeong","year":"2016","journal-title":"Investig. Clin. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Madarasz, Z., Nowakowski, K., Leitz, M., Sturzu, B.C., Baltamar, A., Baginski, K., Hoyer, A., Vladimirov, M., Hoeppner, J., and Nimczewski, F. (2026). Learning curves and outcomes of robotic colorectal surgery: A single-surgeon experience within a structured dual-console training program. J. Robot. Surg., 20.","DOI":"10.1007\/s11701-025-03139-x"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2820","DOI":"10.1007\/s00464-016-5292-0","article-title":"Developing a robotic colorectal cancer surgery program: Understanding institutional and individual learning curves","volume":"31","author":"Guend","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tang, B., Li, T., Gao, G., Shi, J., and Li, T. (2022). Learning Curve of Robotic-Assisted Total Mesorectal Excision for Rectal Cancer. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.931426"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5669\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:14:42Z","timestamp":1784535282000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":23,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145669"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145669","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}