Short-term Outcome of Robot-assisted and Open IPAA

摘要

BACKGROUND: The potential advantages of robot-assisted laparoscopy are being increasingly investigated, although data on its efficacy in benign colorectal surgery are scarce. OBJECTIVE: We compared the early postoperative outcome in robot-assisted IPAA with open surgery procedures. DESIGN: This was an observational study based on prospectively collected data obtained from chart reviews. SETTING: The single-center data set covers patients operated on from January 13, 2004, to September 16, 2014, at a specialist center. PATIENTS: Patients with ulcerative colitis undergoing IPAA surgery were included. MAIN OUTCOME MEASURES: Study end points included the duration of operation, admission length, complications (Clavien-Dindo), reoperations, and readmissions. RESULTS: Eighty-one robot-assisted and 170 open IPAA procedures were performed. The duration of operation was significantly longer for robot-assisted laparoscopic procedures (mean difference, 154 minutes; CI, 140-170). During a mean follow-up of 102 days, no significant differences in the distribution of complications were found (Spearman p = 0.12; p = 0.07), and no postoperative deaths occurred in either group. Postoperative admission length was shorter following robot-assisted procedures (mean difference, -1.9; CI, -3.5 to -0.3), whereas 40% of patients were readmitted, compared with 26% of patients who had open surgery (OR, 1.9; CI, 1.1-3.4). Pouch failure occurred in 3 patients (1 following robot-assisted laparoscopy; 2 following open surgery). On multivariate regression analyses, robot-assisted laparoscopy was associated with a significantly longer duration of operation (mean difference, 159 minutes; CI, 144-174), and more readmissions for any cause (OR, 2; CI, 1.1-3.7). LIMITATIONS: This was a nonrandomized, single-center observational study. CONCLUSION: In this implementation phase, robot-assisted IPAA surgery offers acceptable short-term outcomes. The limitations of this observational study call for randomized controlled trials with long-term follow-up and exploration of functional results.