When seconds matter - introducing a surgical salvage strategy by emergency robotic surgery: a review.

Abstract

Robotic surgery has expanded minimally invasive options but introduces specific vulnerabilities during intraoperative emergencies. The physical separation of the surgeon from the patient, restricted access due to docking, and dependence on complex technology can delay life‑saving interventions if teams are not prepared. This review summarizes current evidence and expert practice on emergency management along the perioperative pathway in robotic surgery, focusing on a structured, systems‑based salvage strategy. Key domains include preoperative planning, classification of recoverable and non‑recoverable errors, and standardized protocols for rapid undocking, conversion, hemorrhage control, and resuscitation. Particular emphasis is placed on human factors, including visible name tags, closed‑loop communication, and structured briefings to strengthen situational awareness and role clarity in crises. Simulation‑based curricula and high‑fidelity in situ drills are highlighted as essential for rehearsing rare but high‑impact events such as catastrophic bleeding, cardiorespiratory collapse, or robotic system failure. In parallel, technology‑driven tools such as surgeon‑controlled suction, advanced vessel sealing, and artificial‑intelligence-assisted monitoring are discussed as adjuncts for earlier recognition and standardized documentation of critical events. Integrating these elements into protocolized workflows can improve preparedness, shorten response times, and support safer decision‑making when seconds matter in robotic surgery.