Open vs. laparoscopic vs. robotic pouch excision: unveiling the best approach for optimal outcomes

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Restorative proctocolectomy with ileal pouch-anal anastomosis is used for ulcerative colitis, Crohn's disease, and familial adenomatous polyposis.
• Pouch failure necessitates pouch excision, with open surgery carrying potential complications.
• Comparative data for emerging robotic and laparoscopic techniques in pouch excision are limited.

Purpose of the Study:

• To compare the outcomes of robotic, laparoscopic, and open ileal pouch excision.
• To evaluate short-term postoperative complications associated with different surgical approaches.

Main Methods:

• Retrospective study of 123 adult patients undergoing ileal pouch excision (robotic, laparoscopic, or open) from 2015-2023.
• Analysis of patient characteristics, perioperative variables, and short-term postoperative outcomes.
• Statistical comparison of complication rates, operative time, and blood loss across the three surgical groups.

Main Results:

• Robotic surgery showed significantly lower estimated blood loss (EBL) and fewer 30-day postoperative complications than open surgery.
• Robotic and laparoscopic approaches required fewer preoperative ureteral stents than open surgery.
• Robotic procedures had fewer pelvic drainages and lower rates of lysis of adhesions compared to open surgery, with fewer 30-day reoperations than laparoscopic.

Conclusions:

• Robotic-assisted pouch excision demonstrates significant advantages over open surgery.
• Benefits include decreased EBL, reduced need for preoperative ureteral stents, and fewer 30-day postoperative complications.
• Minimally invasive techniques like robotic surgery show promise for improving outcomes in ileal pouch excision.