The Germans Trias Hospital, popularly known as Can Ruti and located in Badalona, has taken a decisive step by consolidating the Europe's first emergency robotic surgery programA pioneering project that is now fully operational after just over a year of development. This model positions the Catalan center as a reference in robotic surgery in robot-assisted emergency surgical care.
What initially seemed like a brave and almost experimental gamble has transformed into a structured clinical activity, with measurable and published results in scientific journals. Robotic surgery, until now largely reserved for scheduled procedures, has been integrated into the hospital's emergency circuit with a robot available 24 hours a day, 365 days a year.
A unique 24/7 program in Europe
The program, launched in the fall of 2024, has been designed to provide the hospital with a robotic surgical system exclusively for emergenciesIt operates continuously, including at night and on weekends. The goal is not simply to "make room" in the robot's schedule, but to have it always ready for any urgent intervention that may be required.
To make this possible, it has been necessary to enable a specific physical space and a highly refined logistical organization, example of the deployment of robotic surgeryThe emergency circuit includes operating rooms prepared for robotic surgery, with equipment that can be activated in a matter of minutes, something especially relevant in time-dependent pathologies.
Dr. José María Balibrea, head of the General and Digestive Surgery Service and director of the Emergency Surgery Unit, explains that the center is currently the only European hospital with a fully implemented emergency robotic surgery programAs he explains, this involves not only technology, but also profound changes in the way we work and in the organization of human resources.
Since the project's inception, the unit has carried out nearly 300 urgent interventions with robotic assistanceThis makes the program the most active in Europe in this area, a sign that Robotic surgery gains momentumThis range of cases has allowed us to accumulate real experience, beyond the isolated cases that were previously common in the emergency departments of most hospitals.
Clinical outcomes: fewer complications and shorter stays
The first data from the program has been collected in a evaluation of the first ten months of operationThe study, recently published in the Journal of Robotic Surgery, one of the world's leading publications in robotic surgery, highlights that the results not only support the viability of the model but even exceed initial expectations, demonstrating that Robotic surgery is advancing in Spain.
During this period, the average length of stay for patients undergoing urgent robotic surgery was less than two days of hospital admissionThis is a very competitive figure compared to conventional surgery. Furthermore, the complication rate did not exceed 5% and readmissions were below 3%, indicators that point to safe and well-controlled care.
Another piece of data that particularly caught the attention of the clinical team is the low level of postoperative painAccording to the experience gathered, 96% of the people who underwent the procedure reported minimal or no pain in the first 48 hours after the operation, something that has a direct impact on patient comfort and the need for analgesia.
The surgeons emphasize that these results are particularly valuable in the context of emergency medicine, where patients' conditions are traditionally often critical. more complex and less controllable than in scheduled interventions. Achieving such low complication rates and such short stays in this setting reinforces the interest in this type of approach.
What types of surgeries are performed with the robot in the emergency room?
Most of the interventions carried out so far within the program correspond to acute appendicitis and acute cholecystitisThese conditions represent more than 80% of the emergency surgeries performed with robotic assistance since the project's inception. In this group of pathologies alone, approximately 130 procedures have been recorded in the first few months.
In the case of acute cholecystitis (removal of the gallbladder in an inflammatory context), the team has been able to to treat patients of all profiles and levels of difficultywithout ruling out complex cases. According to the professionals, the robotic platform has allowed them to perform all the desired complementary maneuvers, with clinical results rated as very good.
Beyond these more frequent pathologies, the robot has also proven to be of great help in gastric perforations due to ulcers, complicated appendicitis, or strangulated inguinal herniasIn scenarios where the anatomy is altered or there is significant inflammation, the magnified three-dimensional vision and precision of robotic arms offer a clear advantage.
The emergency team emphasizes that the service's work philosophy is based on the fact that “The most difficult patient is the one who most needs the best available technology”In this sense, the robot is not reserved for simple cases, but is used precisely in those where it is expected to make a difference in safety or results.
Looking ahead to the program's second year, the professionals are considering to expand the range of urgent surgeries performed robotically, including the robotic surgery in pediatricsas well as increasing the proportion of emergency cases that are operated on with this assistance compared to traditional laparoscopic or open surgery.
Organization, training and logistics: the three keys to the model
As Dr. Balibrea points out, one of the strengths of the Germans Trias experience is not only the technology itself, but the structured implementation of the program in a tertiary university hospitalThe model is based on three major organizational pillars that have been fundamental to its success.
The first is the Multidisciplinary training of surgical and nursing staffCurrently, three out of four on-call surgeons have already received specific training in robotic surgery, ensuring that the system can be used safely at any time. Furthermore, the most experienced robotic surgeons volunteered to perform a kind of "role-study" to accompany and support less experienced professionals during the initial procedures.
The second pillar is standardization of surgical proceduresVery clear protocols have been defined for the different types of emergency surgery, which reduces variability, facilitates the learning curve and allows maintaining quality of care even in situations of high healthcare pressure.
The third key element is the Logistical optimization to always have a dedicated robotic system available for emergenciesThis involves scheduling, preventative maintenance, and coordination with other hospital services to avoid overlaps and ensure the robot is available when needed for a real emergency.
External auditors who have analyzed the program have rated the implementation of the model as an exampleThis has helped to spark interest from other centers, especially in northern European countries, which are closely following the evolution of this pioneering experience, and in regions seeking to position themselves as international hub for robotic surgery.
Impact on patients and the healthcare system
Robot-assisted surgery offers a number of advantages already known in scheduled surgery, which become even more significant in the emergency setting. even greater relevanceAmong them are the millimeter precision of the movements, the improvement of the surgeon's field of vision, the reduction of intraoperative bleeding and less trauma to the tissues.
These characteristics translate into shorter recovery times, less postoperative pain, and a reduced risk of complicationsIn an emergency department, where patients often arrive with acute and sometimes unstable conditions, having a tool that minimizes the impact of surgery can make a significant difference.
From an economic point of view, the Germans Trias team acknowledges that the The main barrier is the direct cost of robotics technologyThis applies to both initial investment and maintenance and consumable materials. However, they point out that, when considering the savings in indirect costs—such as reduced use of pain medication, fewer serious complications, and shorter hospital stays—the overall balance is favorable for the healthcare system.
One example cited by surgeons is that of a severe complication in acute cholecystitiswhich can amount to hundreds of thousands of euros in healthcare costs. If robotic surgery helps reduce the likelihood of these scenarios, the investment in technology could pay for itself much sooner than expected.
Furthermore, the program has a direct effect on the equity in access to high technologyPatients arriving at the hospital in the worst condition, usually due to an emergency, have access to the same robotic platform used in complex scheduled surgeries, avoiding a gap in care between the two groups.
From pioneering experience to international benchmark
The Germans Trias initiative has sparked curiosity and expectations in other European hospitalsand in projects like the first robotic telesurgery program, interested in replicating the model. The combination of good clinical results, solid organization and teaching vocation has placed Can Ruti on the map of surgical innovation.
As a next step, the hospital will lead an international registry of emergency robotic surgeryThis registry will allow monitoring the quality of the activity, sharing data between centers, and accumulating sufficient case studies to consolidate the scientific evidence on this type of approach in different pathologies.
Meanwhile, the team is working on the design of Specific clinical trials to evaluate the advantages of the robotic approach compared to other techniques in different emergency scenarios. The goal is to have robust comparative studies that help healthcare systems make informed decisions about incorporating this technology.
Meanwhile, robotic surgery in other areas, such as certain types of tumors, It has already reached usage rates exceeding 90%. en some centersHowever, in benign pathology and in the field of emergencies there is still ample room for growth, especially in areas such as abdominal wall surgery.
Looking to the immediate future, Germans Trias also envisions Taking the first steps in emergency pediatric robotic surgery, an even more incipient field, as well as continuing to expand the catalog of interventions that can benefit from this technology within the emergency service itself.
A center of excellence in interventional robotics
The development of this program has been made possible thanks to impetus from the Daniel Bravo Andreu Private Foundation, which has contributed to providing the hospital with the robotic equipment necessary for the creation of the Germans Trias Interventional Robotics Center.
This center not only supports general and digestive surgery, but also It opens the door for other specialties to incorporate robotics. in its procedures, both scheduled and urgent. In this way, Can Ruti consolidates its position as one of the leading centers in the country for robot-assisted surgery and interventional procedures.
From a teaching perspective, the university hospital takes advantage of this infrastructure to train new generations of surgeons and nursing staff in the use of robotics in real-world contexts, beyond simulators. This practical training is key for the technology to cease being exceptional and become integrated into the routine of surgical services.
The team insists that the normalization of robotic surgery in emergency settings It involves ceasing to see it as an extraordinary resource and accepting it as just another tool, at the same level as conventional laparoscopy, provided there are clear indications and trained professionals.
With the robot operating 24 hours a day, solid clinical results, and a well-oiled organizational structure, the emergency robotic surgery program at Germans Trias Hospital has become A practical example of how to integrate high technology into urgent care without losing sight of the system's sustainability. What began as a pioneering project is now a real model that other European centers are watching closely and that aims to gradually transform the way emergency surgery is understood.
