Entirely Robot-assisted Total Colectomy/Total Proctocolectomy Compared With a Laparoscopic Approach.

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Gastrointestinal Surgery

Background:

• Robot-assisted surgery for total colectomy/proctocolectomy (TC/TPC) has historically involved combining robotic and open/laparoscopic approaches.
• An integrative, entirely robot-assisted method for TC/TPC has not been widely described.

Purpose of the Study:

• To describe an integrative, entirely robot-assisted method for total colectomy/proctocolectomy (TC/TPC).
• To maintain anatomical dissection using single docking and one-off arm placement in robot-assisted TC/TPC.

Main Methods:

• A cohort of 20 patients undergoing robot-assisted TC/TPC was compared with 36 patients undergoing laparoscopic procedures.
• Data collected included operative time, conversion rates, and postoperative adverse events.

Main Results:

• Robot-assisted TC/TPC had a longer mean operative time (approx. 1 hour) compared to laparoscopic surgery (P=0.003).
• No patients in the robot-assisted group required conversion to open surgery, versus 8% in the laparoscopic group.
• Postoperative adverse event rates were similar between groups (P=0.063).
• Short ileal pouches (8 cm) were used in all robot-assisted TPC/ileal-pouch anal anastomosis cases, with no difference in bowel movement frequency at 6 months compared to longer pouches.

Conclusions:

• The described robot-assisted technique successfully integrated anatomical dissection for TC/TPC, eliminating the need for conversion to open surgery.
• Further refinement of robotic techniques may address concerns regarding time, cost, and technical aspects.