Comparative outcomes of robotic versus laparoscopic total proctocolectomy

Total proctocolectomy (TPC) with end ileostomy is performed for inflammatory bowel disease (IBD) or diffuse polyposis/malignancy, but evidence regarding robotic versus laparoscopic TPC remains limited. We hypothesized that robotic TPC is associated with lower conversion rates. We queried the National Surgical Quality Improvement Program's proctectomy database (2016-2023) for adult patients undergoing elective TPC for IBD or polyposis/malignancy. Cases were categorized by intended approach (robotic versus laparoscopic). Conversion to open surgery served as the primary endpoint, with operative time, postoperative organ space infections, and renal complications as secondary outcomes. Among 2,035 patients, 1,505 (74%) underwent laparoscopic and 530 (26%) robotic TPC. Robotic utilization increased from 13% in 2016 to 38% in 2023 (p < 0.001). The robotic approach was more frequently utilized for male patients (59.1% vs. 50.2%, p < 0.001) and those with malignancy (47.4% vs. 32.1%, p < 0.001) and preoperative chemotherapy (17.6% vs. 9.6%, p < 0.001). Conversion to open surgery occurred less often with the robotic approach (5.5% vs. 8.8%, p = 0.01), though operative duration was longer (398 vs. 311 min, p < 0.001). In adjusted models, robotic TPC showed lower odds of conversion (OR = 0.66 [95% CI 0.45-0.96]) but higher odds of organ space infection (OR = 1.57 [95%CI 1.10-2.23]) and renal complications (OR = 2.25 [95%CI 1.13-4.47]), with 78 additional minutes of operative time (β = 78 [95%CI 66-90]). Robotic TPC is associated with lower conversion rates but prolonged operative time and increased incidence of renal complications and organ space infections. These results aid patient counseling and inform preoperative decision making.