Presentation (CTI)

OBJECTIVES: Conversions of minimally-invasive procedures to open surgery are discrete, costly intraoperative events. This study quantifies how many such conversions robotic-assisted surgery (RAS) has avoided in Swedish colorectal cancer over a decade compared with a year-matched laparoscopic counterfactual, and the direct cost avoided.
METHODS: National-level annual case volumes and conversion-to-open rates for RAS and laparoscopy in colon and rectal cancer were extracted from the Swedish ColoRectal Cancer Registry (SCRCR) for 2015-2024. Analyses were conducted at the level of surgical approach, consistent with registry reporting structures, to characterise real-world adoption and its resource-use consequences rather than to evaluate individual devices. For each year, the contemporaneous laparoscopic conversion rate was applied to the robotic case volume to estimate counterfactual conversions. Subtracting observed RAS conversions gave the avoided conversions, valued at 54,006 SEK each (2024 prices). Downstream consequences (e.g. complications) were excluded, yielding a conservative estimate.
RESULTS: 9,185 RAS colorectal cancer procedures were performed (2,760 colon and 6,425 rectal). Over the decade, both RAS and laparoscopic conversion rates declined, most clearly in rectal cancer (laparoscopy fell from 21.4% to 13.8%, RAS from 12.8% to 4.3%). The RAS-vs-laparoscopy gap ranged from 3-10 percentage points throughout, consistent with a sustained difference rather than a learning-curve effect. RAS avoided an estimated 645 conversions versus the same-volume laparoscopic counterfactual (205 colon, 440 rectal), equivalent to 34.8 million SEK (≈ 3.0 million EUR) in direct cost. Annual avoided cost rose from 2.2 million SEK in 2015 to 8.3 million SEK in 2024, a 3.7-fold increase driven mostly by RAS volume growth.
CONCLUSIONS: A decade of Swedish national-registry data shows that RAS maintains a stable conversion-rate advantage over laparoscopy in colorectal cancer, even as both techniques have matured. Findings support continued investment in robotic capacity for colorectal cancer surgery and the inclusion of conversion-avoidance among outcomes in health-technology assessments of minimally-invasive approaches.