Comparison of laparoscopic and robotic surgery for inflammatory bowel disease: a systematic review and meta-analysis.

Abstract

Background: Refractory inflammatory bowel disease (IBD) often requires surgery. Ulcerative colitis (UC) usually needs proctocolectomy, while Crohn's disease (CD often involves multiple surgeries, with ileocecal resection (ICR) being the most common. Minimally invasive approaches offer faster recovery and fewer complications. Laparoscopy is established for IBD. Robotic surgery has shown its potential. This review updates evidence on robotic versus laparoscopic techniques in IBD surgery.

Methods: PubMed, Scopus, CINAHL, and Cochrane databases were searched for papers comparing laparoscopic versus robotic surgery in IBD patients. Odds-ratio and weighted mean differences were calculated using models with random-effects. Risk of bias was evaluated with the Newcastle-Ottawa scale.

Results: Fifteen papers reporting the outcomes of 13.225 patients were included. Papers were stratified into three categories: ICR for CD, Subtotal colectomy (SC) for UC, and proctectomy and ileal pouch-anal anastomosis (IPAA) for UC. Higher operative time was reported in the robotic cohorts (ICR 67.3 p < 0.01, SC 63.5 p < 0.001, and IPAA 39.7 p < 0.001), with a reduced conversion rate (ICR - 0.73 p = 0.02, IPAA - 0.4 p = 0.5). Outcomes were comparable for overall complications (ICR 0.1 p = 0.64, SC - 0.09 p = 0.4, and IPAA 0.01 p = 0.96) surgical (ICR - 0.58 p = 0.01, SC - 0.2 p = 0.09, IPAA - 0.3 p = 0.2) and medical complications (ICR - 0.18 p = 0.7, SC - 0.2 p = 0.2, and IPAA 0.56 p = 0.48). A slight advantage in hospital stay has been documented (ICR - 0.66 p = 0.03, SC - 0.7 p = 0.28, and IPAA - 0.29 p = 0.5).

Conclusions: This meta-analysis demonstrates a slight advantage of robotic surgery over laparoscopy in IBD patients. While robotic surgery is a valid option, evidence is limited, and a cost analysis is required to justify its higher expense.