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Comparative outcomes of robotic versus laparoscopic total proctocolectomy
Sarah E Rudasill1, Rebecca B Tang1, Hannah M Bossie2
1Department of Surgery, Massachusetts General Hospital, Boston, USA.
Journal of Robotic Surgery
|July 20, 2026
Summary
Robotic total proctocolectomy (TPC) reduces conversion to open surgery but increases operative time and complications like organ space infections and renal issues. This finding aids patient counseling and surgical decision-making for inflammatory bowel disease or malignancy.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Total proctocolectomy (TPC) with end ileostomy is a standard procedure for inflammatory bowel disease (IBD) and malignancy.
- Evidence comparing robotic versus laparoscopic approaches for TPC is limited.
- Understanding comparative outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To compare the outcomes of robotic versus laparoscopic TPC.
- To investigate the hypothesis that robotic TPC is associated with lower conversion rates.
- To analyze secondary outcomes including operative time and postoperative complications.
Main Methods:
- Retrospective analysis of the National Surgical Quality Improvement Program proctectomy database (2016-2023).
- Inclusion of adult patients undergoing elective TPC for IBD or polyposis/malignancy.
- Categorization by intended surgical approach (robotic vs. laparoscopic) with conversion to open surgery as the primary endpoint.
Main Results:
- Robotic TPC was associated with significantly lower conversion rates (5.5% vs. 8.8%, p=0.01).
- Robotic TPC showed increased operative time (398 vs. 311 min, p<0.001) and higher odds of organ space infection and renal complications.
- Robotic utilization increased significantly from 2016 to 2023.
Conclusions:
- Robotic TPC offers a lower conversion rate compared to laparoscopic TPC.
- The benefits of reduced conversion must be weighed against increased operative time and potential for specific postoperative complications.
- Findings support informed patient counseling and preoperative decision-making regarding surgical approach.
