Robotic multiquadrant colorectal procedures: A single-center experience and a systematic review of the literature

Abstract

PurposeRobotic surgery has been progressively implemented for colorectal procedures but is still limited for multiquadrant abdominal resections. The present study aims to describe our experience in robotic multiquadrant colorectal surgeries and provide a systematic review and meta-analysis of the literature investigating the outcomes of robotic total proctocolectomy (TPC), total colectomy (TC), subtotal colectomy (STC), or completion proctectomy (CP) compared to laparoscopy.MethodsAt our institution 16 consecutive patients underwent a 2- or 3-stage totally robotic total proctocolectomy (TPC) with ileal pouch-anal anastomosis. A systematic review of the literature was performed to select studies on robotic and laparoscopic multiquadrant colorectal procedures. Meta-analyses were used to compare the two approaches.ResultsIn our case series, 14/16 patients underwent a 2-stage robotic TPC for ulcerative colitis with a mean operative time of 271.42 (SD:37.95) minutes. No conversion occurred. Two patients developed postoperative complications. The mean hospital stay was 8.28 (SD:1.47) days with no readmissions. Mortality was nil. All patients underwent loop-ileostomy closure, and functional outcomes were satisfactory. The literature appraisal was based on 23 retrospective studies, including 736 robotic and 9,904 laparoscopic multiquadrant surgeries. In the robotic group, 36 patients underwent STC, 371 TC, 166 TPC, and 163 CP. Pooled data analysis showed that robotic TC and STC had a lower conversion rate (OR = 0.17;95% CI, 0.04–0.82; p = 0.03) than laparoscopic TC and STC. The robotic approach was associated with longer operative time for TC and STC (MD = 104.64;95% CI, 18.42–190.87; p = 0.02) and TPC and CP (MD = 38.8;95% CI, 18.7–59.06; p = 0.0002), with no differences for postoperative complications and hospital stay. Reports on urological outcomes, sexual dysfunction, and quality of life were missing.ConclusionsOur experience and the literature suggest that robotic multiquadrant colorectal surgery is safe and effective, with low morbidity and mortality rates. Nevertheless, the overall level of evidence is low, and functional outcomes of robotic approach remain largely unknown. Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022303016.

Conversion to open surgery in minimally invasive surgery for ileocolonic Crohn’s disease: a national multicentre study

“…Although not statistically relevant, we observed no conversions in our limited robotic cohort. A 2018 systematic review reported a conversion rate of 7.3%, while a more recent one from 2022 reported conversion rates of 1.7% and 3.4% for total/subtotal colectomy and total proctocolectomy/completion colectomy, respectively [28], [29]. In 2021, Flynn et al observed similar learning curves for robotic and laparoscopic surgery as well as lower conversion rates, especially during the early phases of learning [30].…”

State of the Art: Pouch Surgery in the 21st Century

“…The choice between laparoscopic and robotic IPAA currently seems to depend mostly on the surgeon’s preference, platform availability, and type of practice, given the high costs of the robot and the lack of evidence on its superiority compared to laparoscopy. As with other procedures that require multiquadrant exposure, TPC can also be performed with a combination of laparoscopy and robotics, 66 maximizing the advantages of the 2 approaches. Particular attention should be paid to technical minutiae, such as the extent of pelvic dissection and correct mesentery alignment, when performing MI-IPAA.…”

A Comparison of Clinical Outcomes of Robot-Assisted and Conventional Laparoscopic Surgery

“…Twenty-three reviews on colectomy were included [30,31,37,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Of the twentythree reviews, two were systematic reviews [30,57], eighteen were meta-analyses [31,37,39,40,[42][43][44][45][46][47][49][50][51][52][53]55,56,58], and three were network meta-analyses [41,48,54]. The corrected covered area of the 23 reviews was 2.6% (slight overlap).…”