Robotic vs. laparoscopic IPAA in a high-volume referral centre: a retrospective observational study

Ileal pouch-anal anastomosis (IPAA) represents the gold standard in ulcerative colitis patients refractory to medical therapy. While laparoscopy is a well-established alternative to open surgery, further comparative evidence between laparoscopy and robotic approaches is required. This study aims to evaluate intraoperative performance and short-term postoperative outcomes in laparoscopic and robotic IPAA in a high-volume referral centre. This retrospective single-centre study evaluated consecutive patients undergoing minimally invasive proctectomy with IPAA and diverting loop ileostomy between 2017 and 2025 at Sant' Orsola University Hospital, Bologna. Demographic, clinical, surgical, and postoperative data were compared between the laparoscopic and robotic cohorts using a propensity score-matched analysis. This study included 169 patients: 131 in the laparoscopic group and 38 in the robotic one. Demographic characteristics were comparable. The robotic cohort presented a lower conversion rate, though this did not reach statistical significance (13.0% vs. 2.6%, p = 0.078). On the other hand, it presented a faster return to oral diet (p < 0.001). Length of stay, duration of surgery and overall postoperative complications were comparable. The laparoscopic cohort experienced more severe complications (7% Clavien-Dindo ≥ III), while the robotic cohort did not exceed a Grade II. No robotic cases required reoperation at 30 days, compared to 2.3% in the laparoscopic group. Robotic IPAA yielded results comparable to laparoscopy regarding length of stay, duration of surgery and rate of complications. However, the robotic approach showcased a trend towards decreased conversion and 30-day reoperation. It was also associated with decreased complication severity, and faster return to an oral diet, suggesting a potential to expedite and enhance postoperative recovery.