Minimally invasive surgery for Inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques

Shafquat Zaman; Ali Yasen Y Mohamedahmed; Widad Abdelrahman; Hashim E Abdalla; Ali Ahmed Wuheb; Mohamed Talaat Issa; Nameer Faiz; Nuha A Yassin

doi:10.1093/ecco-jcc/jjae037

Minimally invasive surgery for Inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques

J Crohns Colitis. 2024 Mar 11:jjae037. doi: 10.1093/ecco-jcc/jjae037. Online ahead of print.

Authors

Shafquat Zaman^{1

2}, Ali Yasen Y Mohamedahmed³, Widad Abdelrahman³, Hashim E Abdalla³, Ali Ahmed Wuheb³, Mohamed Talaat Issa⁴, Nameer Faiz⁴, Nuha A Yassin^{2

5}

Affiliations

¹ Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.
² College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
³ Department of Colorectal and General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK.
⁴ Department of General Surgery, Russells Hall Hospital, Dudley Group NHS Trust, Dudley, West Midlands, UK.
⁵ Department of Colorectal and General Surgery, University Hospitals Birmingham NHS Trust, Birmingham, West Midlands, UK.

PMID: 38466108
DOI: 10.1093/ecco-jcc/jjae037

Abstract

Background: To evaluate outcomes of robotic versus conventional laparoscopic colorectal resections in patients with inflammatory bowel disease (IBD).

Methods: Comparative studies of robotic versus laparoscopic colorectal resections in patients with IBD were included. Primary outcome was total post-operative complication rate. Secondary outcomes included operative time, conversion to open surgery, anastomotic leaks, intra-abdominal abscess formation, ileus occurrence, surgical site infection, re-operation, re-admission rate, length of hospital stay, and 30-day mortality. Combined overall effect sizes were calculated using random-effects model and the Newcastle-Ottawa Scale was used to assess risk of bias.

Results: Eleven non-randomised studies (n=5,566 patients) divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery were included. Robotic platforms were associated with a significantly lower overall post-operative complication rate compared with laparoscopic surgery (P=0.03).Laparoscopic surgery was associated with a significantly shorter operative time (P=0.00001). No difference was found in conversion rates to open surgery (P=0.15), anastomotic leaks (P=0.84), abscess formation (P=0.21), paralytic ileus (P=0.06), surgical site infections (P=0.78), re-operation (P=0.26), re-admission rate (P=0.48), and 30-day mortality (P=1.00) between the groups.Length of hospital stay was shorter following a robotic sub-total colectomy compared with conventional laparoscopy (P=0.03).

Conclusion: Outcomes in the surgical management of IBD are comparable between traditional laparoscopic techniques and robotic-assisted minimally invasive surgery demonstrating the safety and feasibility of robotic platforms. Larger studies investigating the use of robotic technology in Crohn's disease and ulcerative colitis separately may be of benefit with specific focus on important IBD-related metrics.

Keywords: inflammatory bowel disease; minimally invasive surgery; robotic surgery.