Early Experience With Robotic Approaches to Inflammatory Bowel Disease Surgery: A Single-Center Study

Background Understanding the surgical outcomes following surgery for inflammatory bowel disease (IBD) is crucial for proper consent and informed decision-making. Contemporary recommendations to guide IBD surgical intervention now favor a minimally invasive approach, if possible. We present surgical outcomes following the introduction of robotic minimally invasive surgery (MIS) for IBD in a tertiary center. Aim Robotic approaches to colorectal resections are now becoming routine for colorectal cancer surgery but use in IBD is still not currently mainstream. Here, we describe our initial experience with robotic IBD surgery and compare 30-day surgical outcomes to laparoscopic and open approaches. Methods A single tertiary referral center experience of all patients over 16 years of age undergoing surgery for IBD between 2020 and 2023 was analyzed. This retrospective review of all prospectively gathered surgical data utilized the hospital database and prospectively recorded ERAS (Enhanced Recovery After Surgery) records detailing patient recovery and complications. For the statistical calculations, we used ANOVA for overall data and Tukey's HSD for comparing each cohort. Results A total of 140 cases were analyzed, showing mean procedure time in minutes across robotic, laparoscopic, and open approaches (p=0.997): colectomies (268, 282, 265), panproctocolectomies (380, 425, 382), proctectomies (315, 259, 228), and small bowel resections (161, 165, 202). There was zero mortality across all groups. For robotic, laparoscopic, and open approaches, the major complications (Clavien-Dindo classification 3+) rates were 5.4%, 8%, and 3.5% (p=0.686), respectively, and the readmission rates were 8.10%, 9.33%, and 21.42%, respectively. The mean post-operative stays in days (p=0.164) were as follows: colectomies (6.70, 8.45, 10.33), panproctocolectomy (8.40, 8.92, 10.29), completion proctectomy (6.00, 5.00, 8.20), and ileocecal/small bowel resection (6.42, 6.46, 6.80). The costs for patients undergoing robotic surgery were higher (p=0.11). Conclusion This early data demonstrate real-world experience of the introduction of robotic surgical techniques for colorectal resection. Robotic surgical outcomes demonstrate equivalence with the laparoscopic outcomes and are improved compared to open procedures in most metrics but are more expensive.