Robotic versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis

Abstract

Background

Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) is a curative and cancer preventative procedure in patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). It can be technically difficult laparoscopically, and hence the robotic platform has been suggested as a way to enable minimally invasive surgery in more patients. This systematic review examines robotic proctectomy or proctocolectomy with IPAA. A limited meta-analysis was performed on data comparing the robotic approach to laparoscopy.

Methods

We searched MEDLINE, EMBASE and the Cochrane database for case series of robotic IPAA procedures and studies comparing the robotic to laparoscopic or open procedures. Data examined includes operating time, conversion to open, length of stay, complications, blood loss, return of bowel function, reoperation rate and functional outcomes.

Results

Five non-randomised studies compared robotic to laparoscopic techniques; one compared robotic to open surgery and three case series are included. Operating time was significantly longer in robotic cases. Estimated blood loss was significantly less in three of four studies which reported this; hospital stay was significantly less in two. There were nonsignificant reductions in complications and readmission rates. Pooled analysis of four papers with adequate data showed a nonstatistically significant trend to less complications in robotic procedures. Three studies assessed functional and quality of life outcomes, with little difference between the platforms.

Conclusions

Available data suggests that the robotic platform is safe to use for IPAA procedures. There is minimal evidence for clinical advantages, but with little data to base decisions and significant potential for improvements in technique and cost-effectiveness, further use of the platform for this operation is warranted. It is vital that this occurs within an evaluation framework.

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Acknowledgements

The authors gratefully acknowledge the Epworth Knowledge Services’ contribution to collating the required papers for this work.

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Contributions

All authors contributed to the study conception and design, material preparation, data collection and analysis. The first draft of the manuscript was written by J Flynn and JT Larach, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Julie Flynn.

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Conflict of interest

J Flynn: no conflicts of interest or financial ties to disclose. JT Larach: educational grant funded by Intuitive Surgical. J Kong: no conflicts of interest or financial ties to disclose. S Warrier: honorarium for proctoring robotic cases. A Heriot: no conflicts of interest or financial ties to disclose.

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Flynn, J., Larach, J.T., Kong, J.C.H. et al. Robotic versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis. Int J Colorectal Dis (2021). https://doi.org/10.1007/s00384-021-03868-z

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Keywords

  • Robotic surgery
  • Colorectal surgery
  • Restorative proctocolectomy
  • Ileal pouch-anal anastomosis