<p>The adoption of robotic surgery in emergency general surgery has traditionally been limited to sporadic use, mainly because of organizational, logistical, and training-related barriers. Evidence regarding the structured implementation of robotic platforms in a continuous 24/7 emergency setting is scarce. This study aimed to evaluate the implementation and early operational performance of a structured robotic acute care surgery program. We conducted a prospective observational study to describe the implementation and early outcomes of a structured 24/7 robotic acute care surgery program at a tertiary university hospital. A dedicated robotic platform was assigned exclusively to the emergency operating room, supported by a standardized training pathway for surgeons and nursing staff, and protocolized workflows for predefined emergency procedures. All consecutive patients who underwent emergency robotic surgery between October 2024 and June 2025 were included. Procedural and short-term postoperative outcomes, including operative duration, were prospectively collected. The potential influence of surgeon experience and the presence of proctors were explored using factorial analysis of variance (ANOVA), and a complementary multivariable linear regression model including procedure type and ASA class was performed to account for procedural heterogeneity. During the study period, 130 emergency robotic procedures were conducted. The most frequent indications were acute appendicitis (<i>n</i> = 53, 40.8%) and acute cholecystitis (<i>n</i> = 55, 42.3%), followed by a heterogeneous group of other urgent abdominal procedures and reinterventions. Robotic surgery was successfully performed across all shifts, including nights and weekends. The operative time remained stable throughout the implementation period. The presence of experienced proctors mitigated the variability in operative duration during the program’s early phases. No intraoperative conversions related to organizational or technical limitations were observed in this study. The median postoperative length of stay was 2 days (interquartile range [IQR] 2–4). The 90-day complication rate was 5.4%, including 2.3% Clavien-Dindo grade I-II and 3.1% grade III complications, with a readmission rate of 3.1% and no mortality. The structured implementation of a dedicated 24/7 robotic acute care surgery program is feasible and appears to be effectively integrated into routine emergency surgical workflows within a structured institutional framework. Continuous platform availability, standardized protocols, and the presence of a trained multidisciplinary surgical and nursing team, supported when necessary by experienced proctors, are key factors in maintaining operative efficiency during program rollout. Further studies are warranted to assess the long-term outcomes, cost-effectiveness, and comparative effectiveness of this approach versus conventional minimally invasive approaches.</p>