Implementation of a robotic surgery program in Peru: a retrospective cohort study of case mix, perioperative outcomes, and predictors of operative time

Robotic-assisted surgery has transformed minimally invasive surgery worldwide, offering improved precision, visualization, and dexterity. However, evidence describing program implementation and perioperative outcomes in low- and middle-income countries remains limited. This study describes the initial institutional experience of a multidisciplinary robotic-assisted surgery program in Peru. A retrospective cohort study included consecutive adult patients undergoing robotic-assisted surgery during the early implementation phase (December 1, 2024 to March 31, 2026) at a national referral center in Peru. Demographic, clinical, procedural, and perioperative outcomes were collected. Multivariable linear regression identified independent predictors of operative time. A total of 398 robotic-assisted procedures were analyzed. Mean age was 49.8 ± 17.2 years, and 68.2% of patients were female. Most procedures were performed for benign disease (64.8%), followed by malignancy (29.4%) and complex/reconstructive indications (3.8%). Cholecystectomy (18.1%) and hysterectomy (17.6%) were the most common procedures. Mean operative time was 236.8 ± 152.1 min. The conversion rate was 7.5%, postoperative complications occurred in 10.3% of patients, mean length of stay was 7.68 ± 8.17 days, 30-day readmission was 2.5%, and no postoperative mortality occurred. Increasing age (β = 0.85 min/year; p = 0.032), male sex (β = 52.3 min; p = 0.011), and higher ASA classification (β = 8.7 min/category; p < 0.001) independently predicted longer operative time. The model explained 54% of operative-time variability (R²=0.54). Early implementation of a multidisciplinary robotic-assisted surgery program in a Peruvian public referral hospital demonstrated broad procedural adoption, acceptable perioperative outcomes, and predictable variation in operative duration. These findings provide an implementation benchmark for robotic-assisted surgery in resource-limited healthcare systems.