P429 Robotic-assisted vs. laparoscopic proctectomy for inflammatory bowel disease: Results of the case-match comparison in single institution

Abstract

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is considered a procedure of choice in the patients with ulcerative colitis (UC) resistant to medications as well as in selected patients with Crohn disease associated with remittent formation of perianal lesions. The robotic-assisted proctectomy can potentially provide several advantages including beneficial higher precision and less injury when working in the narrow spaces of the pelvis and, presumably, this technique may prevent trauma to the pelvic autonomic nerves providing better functional results A case-matched comparison of 16 robotic and 16 laparoscopic proctocolectomies for IBD performed between April 2014 and March 2017 was carried out. The aim was to evaluate the short-term outcomes in the two groups. Despite the longer surgery duration (298 vs. 264 min, p < 0.05) in the robotic cohort, the reduction of estimated blood loss (179 vs. 288 ml, p < 0.05) and conversion rate (0 vs. 12.5%, p = 0.15) were observed. The bowel movement recovery time (2.3 vs. 2.9 days, p < 0.05) and length of hospital stay (8.7 vs. 9.2 days p < 0.027) were similar in both arms. No readmissions were reported in the groups. At 1-year follow-up, no differences in the rate of postoperative complications (12.5% vs. 18.75%, p = 0.631) and the mean frequency of daily defaecation (3.8 vs. 4.1, p = 0.1) were observed in two arms. In 3 patients in laparoscopic group and 2 in robotic, the anastomotic leakage developed that was treated drainage placement under anaesthesia. In robotic patients, a higher sexual function score than laparoscopic was reported; however, the quality of life score did not differ (p = 0.78). Although the costs for robotic proctectomy are high, the technique allows reducing the estimated blood loss and conversion rate overcoming some limitations of laparoscopic surgery both in ergonomic and accuracy aspects. Besides, the encouraging results regarding the positive impact on sexual function when performing robotic proctectomy were obtained.