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Published on: September 28, 2019
Short-term Outcome of Robot-assisted and Open IPAA: An Observational Single-center Study
Anders Mark-Christensen1, Frederik Rønne Pachler, Charlotte Buchard Nørager
11 Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark 2 Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark 3 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Background:
The potential advantages of robot-assisted laparoscopy are being increasingly investigated, although data on its efficacy in benign colorectal surgery are scarce.
Objective:
We compared the early postoperative outcome in robot-assisted IPAA with open surgery procedures.
Design:
This was an observational study based on prospectively collected data obtained from chart reviews.
Setting:
The single-center data set covers patients operated on from January 13, 2004, to September 16, 2014, at a specialist center.
Patients:
Patients with ulcerative colitis undergoing IPAA surgery were included.
Main Outcome Measures:
Study end points included the duration of operation, admission length, complications (Clavien-Dindo), reoperations, and readmissions.
Results:
Eighty-one robot-assisted and 170 open IPAA procedures were performed. The duration of operation was significantly longer for robot-assisted laparoscopic procedures (mean difference, 154 minutes; CI, 140-170). During a mean follow-up of 102 days, no significant differences in the distribution of complications were found (Spearman p = 0.12; p = 0.07), and no postoperative deaths occurred in either group. Postoperative admission length was shorter following robot-assisted procedures (mean difference, -1.9; CI, -3.5 to -0.3), whereas 40% of patients were readmitted, compared with 26% of patients who had open surgery (OR, 1.9; CI, 1.1-3.4). Pouch failure occurred in 3 patients (1 following robot-assisted laparoscopy; 2 following open surgery). On multivariate regression analyses, robot-assisted laparoscopy was associated with a significantly longer duration of operation (mean difference, 159 minutes; CI, 144-174), and more readmissions for any cause (OR, 2; CI, 1.1-3.7).
Limitations:
This was a nonrandomized, single-center observational study.
Conclusion:
In this implementation phase, robot-assisted IPAA surgery offers acceptable short-term outcomes. The limitations of this observational study call for randomized controlled trials with long-term follow-up and exploration of functional results.
