Navigating Progress: 8-Year Single-Center Experience With Minimally Invasive Proctectomy and IPAA

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Ileal pouch-anal anastomosis (IPAA) is the gold standard for ulcerative colitis, familial adenomatous polyposis, and Crohn's colitis.
• Robotic surgery offers potential advantages in postoperative outcomes and reduced hospital stay.
• Limited comparative studies exist on robotic versus laparoscopic IPAA.

Purpose of the Study:

• To compare short-term (30-day) postoperative outcomes of robotic versus laparoscopic proctectomy with IPAA and diverting loop ileostomy.
• To evaluate differences in complications, length of stay, blood loss, and readmission rates.

Main Methods:

• Retrospective observational study at a single, high-volume tertiary referral center.
• Included 217 adult patients undergoing minimally invasive proctectomy with IPAA and diverting loop ileostomy (2015-2023).
• Compared 30-day complications, length of stay, estimated blood loss, conversion rates, readmissions, and reoperations.

Main Results:

• Robotic IPAA had significantly longer operating times (263 vs. 228 minutes) but lower estimated blood loss (81.5 vs. 126.8 mL) and fewer conversions (0% vs. 8.2%).
• No significant differences were observed in length of stay, 30-day morbidity, readmission, or reoperation rates between groups.
• Robotic patients received more intraoperative fluids (3099 vs. 2472 mL).

Conclusions:

• Robotic proctectomy with IPAA may offer benefits in reduced blood loss and conversion rates while maintaining comparable short-term outcomes to laparoscopy.
• Limitations include retrospective design, single-center data, and lack of long-term and quality-of-life data.
• Further research is needed to assess long-term efficacy and patient-reported outcomes.