Robotic proctocolectomy with ileal pouch-anal anastomosis: a hybrid approach

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the definitive surgical treatment for patients with ulcerative colitis or familial adenomatous polyposis. While laparoscopic surgery has been widely adopted, robotic surgery has emerged as a promising alternative, particularly for complex pelvic dissection. However, the robotic learning curve presents significant challenges. This study introduces a hybrid approach combining robotic and laparoscopic techniques to leverage the strengths of both, with a focus on the impact of the robotic learning curve and surgical training.

All patients undergoing hybrid or laparoscopic proctocolectomy with IPAA for ulcerative colitis between 2022 and 2024 were included. Data on patient characteristics and postoperative outcomes were collected prospectively. Primary outcomes were operating time and 30-day morbidity. All robotic procedures were performed by a consultant surgeon within their first 100 robotic cases.

A total of 25 patients were included: 14 in the hybrid group and 11 in the laparoscopic group. The median operating time was 300 min for the hybrid approach versus 325 min for the laparoscopic approach. In the hybrid surgery group, between 72 and 90% of the laparoscopic part of the procedure was performed by a supervised surgical trainee.

The hybrid robotic-laparoscopic approach offers potential benefits over pure laparoscopy by reducing operative time and postoperative complications. Additionally, it provides a structured modular training opportunity, allowing surgeons to develop both laparoscopic and robotic skills, particularly during the early stages of their robotic learning curve.