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Title: Robotic versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis.
Epworth Authors: Flynn, Julie
Larach, Jose
Other Authors: Kong, Joseph
Warrier, Satish
Heriot, Alexander
Keywords: Colorectal Surgery
Ileal pouch-anal anastomosis
Ulcerative Colitis
Familial Adenomatous Polyposis
Restorative proctocolectomy
Robotic surgery
Department of Surgery, Epworth Healthcare, Bridge Rd, Richmond, Australia
Epworth General Surgery & Gastroenterology Clinical Institute
Issue Date: 2021
Publisher: Springer
Abstract: Background: Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) is a curative and cancer preventative procedure in patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). It can be technically difficult laparoscopically, and hence the robotic platform has been suggested as a way to enable minimally invasive surgery in more patients. This systematic review examines robotic proctectomy or proctocolectomy with IPAA. A limited meta-analysis was performed on data comparing the robotic approach to laparoscopy. <br/>Method(s): We searched MEDLINE, EMBASE and the Cochrane database for case series of robotic IPAA procedures and studies comparing the robotic to laparoscopic or open procedures. Data examined includes operating time, conversion to open, length of stay, complications, blood loss, return of bowel function, reoperation rate and functional outcomes. <br/>Result(s): Five non-randomised studies compared robotic to laparoscopic techniques; one compared robotic to open surgery and three case series are included. Operating time was significantly longer in robotic cases. Estimated blood loss was significantly less in three of four studies which reported this; hospital stay was significantly less in two. There were nonsignificant reductions in complications and readmission rates. Pooled analysis of four papers with adequate data showed a nonstatistically significant trend to less complications in robotic procedures. Three studies assessed functional and quality of life outcomes, with little difference between the platforms. <br/>Conclusion(s): Available data suggests that the robotic platform is safe to use for IPAA procedures. There is minimal evidence for clinical advantages, but with little data to base decisions and significant potential for improvements in technique and cost-effectiveness, further use of the platform for this operation is warranted. It is vital that this occurs within an evaluation framework.
DOI: 10.1007/s00384-021-03868-z
PubMed URL:
ISSN: 1432-1262
Journal Title: International Journal of Colorectal Disease
Type: Journal Article
Affiliated Organisations: Division of Cancer Surgery, University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia
University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia
Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:General Surgery and Gastroenterology

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