Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review

Abstract

The purpose of this study was to assess outcome measures and cost-effectiveness of robotic colorectal resections in adult patients with inflammatory bowel disease. The Cochrane Library, PubMed/Medline and Embase databases were reviewed, using the text “robotic(s)” AND (“inflammatory bowel disease” OR “Crohn’s” OR “Ulcerative Colitis”). Two investigators screened abstracts for eligibility. All English language full-text articles were reviewed for specified outcomes. Data were presented in a summarised and aggregate form, since the lack of higher-level evidence studies precluded meta-analysis. Primary outcomes included mortality and postoperative complications. Secondary outcomes included readmission rate, length of stay, conversion rate, procedure time, estimated blood loss and functional outcome. The tertiary outcome was cost-effectiveness. Eight studies (3 case-matched observational studies, 4 case series and 1 case report) met the inclusion criteria. There was no reported mortality. Overall, complications occurred in 81 patients (54%) including 30 (20%) Clavien-Dindo III–IV complications. Mean length of stay was 8.6 days. Eleven cases (7.3%) were converted to open. The mean robotic operating time was 99 min out of a mean total operating time of 298.6 min. Thirty-two patients (24.7%) were readmitted. Functional outcomes were comparable among robotic, laparoscopic and open approaches. Case-matched observational studies comparing robotic to laparoscopic surgery revealed a significantly longer procedure time; however, conversion, complication, length of stay and readmission rates were similar. The case-matched observational study comparing robotic to open surgery also revealed a longer procedure time and a higher readmission rate; postoperative complication rates and length of stay were similar. No studies compared cost-effectiveness between robotic and traditional approaches. Although robotic resections for inflammatory bowel disease are technically feasible, outcomes must be interpreted with caution due to low-quality studies.

Mortality Rates in Benign Laparoscopic and Robotic Gynecologic Surgery: A Systematic Review and Meta-analysis

“…In a meta-analysis looking at complications in minimally invasive live donor nephrectomy, mortality has been reported to occur in 0.1% (1:1000) of cases [12]. Another review looking at mortality after colorectal resection in patients with inflammatory bowel disease reported a rate of 0% to 1.4% (0−1:140) [13]. This finding is similar to the mortality reported after laparoscopic Roux-en-Y gastric bypass at 0.1% to 2% [14].…”

The future of robotic surgery for inflammatory bowel diseases

“…Robotic surgery lacks eye-hand coordination and perception by the sense of touch which can be managed by training the surgeons on three-dimensional (3D) simulation systems [ 1 ]. Although this novel surgical technique takes more operative time compared to standard laparoscopy and this problem can be improved by gaining experience and surgical expertise [ 6 , 7 ]. The benefits of robotic surgery outweigh the laparoscopic approach calling for further prospective studies to investigate this approach [ 3 ].…”

Roboterassistierte Proktokolektomie mit ileopouchanaler Anastomose bei Verdacht auf hereditäre Polyposis

“…Wie bereits berichtet, können die momentan verfügbaren retrospektiven Studien, die roboterassistierte und laparoskopische Verfahren in diesem Zusammenhang vergleichen, bisher keine für das patientenorientierte Outcome messbaren Vorteile für die Verwendung von Telemanipulationssystemen herausstellen [24 -28]. Dennoch werden die einleitend geschilderten, angeführten Vorteile roboterassistierter Operationsverfahrentrotz intensivem und kontroversem Diskurs [43,44] von erfahrenen Anwendern als gewichtig und nachvollziehbar beurteilt [29,30].…”