Minimally Invasive Surgery for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Robotic Versus Laparoscopic Surgical Techniques

Abstract

Background: We aimed to evaluate outcomes of robotic versus conventional laparoscopic colorectal resections in patients with inflammatory bowel disease [IBD].

Methods: Comparative studies of robotic versus laparoscopic colorectal resections in patients with IBD were included. The primary outcome was total post-operative complication rate. Secondary outcomes included operative time, conversion to open surgery, anastomotic leaks, intra-abdominal abscess formation, ileus occurrence, surgical site infection, re-operation, re-admission rate, length of hospital stay, and 30-day mortality. Combined overall effect sizes were calculated using a random-effects model and the Newcastle-Ottawa Scale was used to assess risk of bias.

Results: Eleven non-randomized studies [n = 5566 patients] divided between those undergoing robotic [n = 365] and conventional laparoscopic [n = 5201] surgery were included. Robotic platforms were associated with a significantly lower overall post-operative complication rate compared with laparoscopic surgery [p = 0.03]. Laparoscopic surgery was associated with a significantly shorter operative time [p = 0.00001]. No difference was found in conversion rates to open surgery [p = 0.15], anastomotic leaks [p = 0.84], abscess formation [p = 0.21], paralytic ileus [p = 0.06], surgical site infections [p = 0.78], re-operation [p = 0.26], re-admission rate [p = 0.48], and 30-day mortality [p = 1.00] between the groups. Length of hospital stay was shorter following a robotic sub-total colectomy compared with conventional laparoscopy [p = 0.03].

Conclusion: Outcomes in the surgical management of IBD are comparable between traditional laparoscopic techniques and robotic-assisted minimally invasive surgery, demonstrating the safety and feasibility of robotic platforms. Larger studies investigating the use of robotic technology in Crohn's disease and ulcerative colitis separately may be of benefit with a specific focus on important IBD-related metrics.

Keywords: Minimally invasive surgery; inflammatory bowel disease; robotic surgery.

Figure 1.

PRISMA flow chart.

Figure 2.

Forest plots of comparison of [1] total complications, [2] total operative time [minutes], [3] conversion to open surgery, [4] anastomotic leak rate, [5] intra-abdominal abscess/collection formation, [6] post-operative ileus occurrence, [7] surgical site infection, [8] re-operation rate, [9] re-admission to hospital, [10] length of hospital stay, and [11] mortality rate. Solid squares denote the mean difference, odds ratio, or risk difference. Horizontal lines represent the 95% confidence intervals [CIs], and the diamond denotes the pooled effect size. Lap, laparoscopic; M–H, Mantel–Haenszel test.

Figure 2.

Forest plots of comparison of [1] total complications, [2] total operative time [minutes], [3] conversion to open surgery, [4] anastomotic leak rate, [5] intra-abdominal abscess/collection formation, [6] post-operative ileus occurrence, [7] surgical site infection, [8] re-operation rate, [9] re-admission to hospital, [10] length of hospital stay, and [11] mortality rate. Solid squares denote the mean difference, odds ratio, or risk difference. Horizontal lines represent the 95% confidence intervals [CIs], and the diamond denotes the pooled effect size. Lap, laparoscopic; M–H, Mantel–Haenszel test.

Figure 2.

Forest plots of comparison of [1] total complications, [2] total operative time [minutes], [3] conversion to open surgery, [4] anastomotic leak rate, [5] intra-abdominal abscess/collection formation, [6] post-operative ileus occurrence, [7] surgical site infection, [8] re-operation rate, [9] re-admission to hospital, [10] length of hospital stay, and [11] mortality rate. Solid squares denote the mean difference, odds ratio, or risk difference. Horizontal lines represent the 95% confidence intervals [CIs], and the diamond denotes the pooled effect size. Lap, laparoscopic; M–H, Mantel–Haenszel test.

Figure 2.

Forest plots of comparison of [1] total complications, [2] total operative time [minutes], [3] conversion to open surgery, [4] anastomotic leak rate, [5] intra-abdominal abscess/collection formation, [6] post-operative ileus occurrence, [7] surgical site infection, [8] re-operation rate, [9] re-admission to hospital, [10] length of hospital stay, and [11] mortality rate. Solid squares denote the mean difference, odds ratio, or risk difference. Horizontal lines represent the 95% confidence intervals [CIs], and the diamond denotes the pooled effect size. Lap, laparoscopic; M–H, Mantel–Haenszel test.

Figure 2.

Forest plots of comparison of [1] total complications, [2] total operative time [minutes], [3] conversion to open surgery, [4] anastomotic leak rate, [5] intra-abdominal abscess/collection formation, [6] post-operative ileus occurrence, [7] surgical site infection, [8] re-operation rate, [9] re-admission to hospital, [10] length of hospital stay, and [11] mortality rate. Solid squares denote the mean difference, odds ratio, or risk difference. Horizontal lines represent the 95% confidence intervals [CIs], and the diamond denotes the pooled effect size. Lap, laparoscopic; M–H, Mantel–Haenszel test.

Figure 2.

Forest plots of comparison of [1] total complications, [2] total operative time [minutes], [3] conversion to open surgery, [4] anastomotic leak rate, [5] intra-abdominal abscess/collection formation, [6] post-operative ileus occurrence, [7] surgical site infection, [8] re-operation rate, [9] re-admission to hospital, [10] length of hospital stay, and [11] mortality rate. Solid squares denote the mean difference, odds ratio, or risk difference. Horizontal lines represent the 95% confidence intervals [CIs], and the diamond denotes the pooled effect size. Lap, laparoscopic; M–H, Mantel–Haenszel test.