Evaluating the Impact of Robotic IPAA: A Case-Matched Analysis from a High-Volume Center

Abstract

Objective: To compare robotic-assisted proctectomy with ileal pouch-anal anastomosis (R-IPAA) outcomes and laparoscopic proctectomy with ileal pouch-anal anastomosis (L-IPAA) within a specialized robotic surgery center, using matching techniques to minimize potential confounding factors.

Summary background data: Minimally invasive approaches, particularly laparoscopy, have improved outcomes for IBD and FAP patients undergoing IPAA. Robotic-assisted surgery offers potential technical advantages, but its definitive superiority over laparoscopy in this context remains under debate.

Methods: This retrospective, STROBE-compliant study analyzed 234 consecutive IPAA patients (117 robotic, 117 laparoscopic). Data encompassed patient demographics, intraoperative details, and postoperative outcomes. We employed various matching techniques to address potential bias. Primary endpoints focused on 30-day complications, readmissions, and reoperations, with secondary endpoints including hospital stay, blood loss, and stoma closure rates.

Results: R-IPAA demonstrated a lower conversion rate to open surgery (P=0.02), a shorter hospital stay (P=0.04), and reduced blood loss (P=0.0003) compared to L-IPAA. While overall 30-day morbidity rates were similar (P=0.4), matched analyses suggested a trend towards fewer reoperations and 3-month IPAA-associated complications after diverting loop ileostomy closure in the robotic group. However, these differences did not reach statistical significance.

Conclusions: In a high-volume robotic surgery center, R-IPAA reduced the risk of conversion to open surgery while reducing intraoperative blood loss and providing shorter length of stay with equivalent perioperative outcomes. Promising trends to reduce 30-day reoperations and surgical complications following DLI closure were observed after a matching analysis.