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Published on: May 29, 2015
Evaluating the Impact of Robotic Ileal Pouch-anal Anastomosis: A Case-matched Analysis From a High-volume Center
Tommaso Violante1,2, Davide Ferrari1, Marco Novelli3
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN.
Objective:
To compare robotic-assisted proctectomy with ileal pouch-anal anastomosis (R-IPAA) outcomes and laparoscopic proctectomy with IPAA within a specialized robotic surgery center, using matching techniques to minimize potential confounding factors.
Background:
Minimally invasive approaches, particularly laparoscopy, have improved outcomes for patients with inflammatory bowel disease and familial adenomatous polyposis undergoing IPAA. Robotic-assisted surgery offers potential technical advantages, but its definitive superiority over laparoscopy in this context remains under debate.
Methods:
This retrospective, "Strengthening the Reporting of Observational Studies in Epidemiology"-compliant study analyzed 234 consecutive patients undergoing IPAA (117 robotic and 117 laparoscopic). Data encompassed patient demographics, intraoperative details, and postoperative outcomes. We employed various matching techniques to address potential bias. Primary endpoints focused on 30-day complications, readmissions, and reoperations, with secondary endpoints including hospital stay, blood loss, and stoma closure rates.
Results:
R-IPAA demonstrated a lower conversion rate to open surgery ( P = 0.02), a shorter hospital stay ( P = 0.04), and reduced blood loss ( P = 0.0003) compared with laparoscopic proctectomy with IPAA. While overall 30-day morbidity rates were similar ( P = 0.4), matched analyses suggested a trend towards fewer reoperations and 3-month IPAA-associated complications after diverting loop ileostomy closure in the robotic group. However, these differences did not reach statistical significance.
Conclusions:
In a high-volume robotic surgery center, R-IPAA reduced the risk of conversion to open surgery while reducing intraoperative blood loss and providing shorter lengths of stay with equivalent perioperative outcomes. Promising trends to reduce 30-day reoperations and surgical complications after diverting loop ileostomy closure were observed after a matching analysis.
