Minimally invasive surgery for Inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques

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 com-
pared 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 tech-
nology in Crohn’s disease and ulcerative colitis separately may be of benefit with a specific focus on important IBD-related metrics.