Advertisement

Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent

  • A. L. LightnerEmail author
  • F. Grass
  • N. P. McKenna
  • M. Tilman
  • A. Alsughayer
  • S. R. Kelley
  • K. Behm
  • A. Merchea
  • D. W. Larson
Original Article
  • 40 Downloads

Abstract

Background

Minimally invasive approaches have become the standard of care for ileal pouch-anal anastomoses (IPAA). There are few reports comparing outcomes following a laparoscopic versus robotic approach. Our aim was to determine if there were any differences in the 30-day postoperative outcomes following IPAA performed laparoscopically versus robotically.

Methods

A retrospective chart review of all laparoscopic and robotic IPAA performed between January 1, 2015 and June 30, 2018 was carried out. Patients included were adult patients who underwent a proctectomy and IPAA utilizing either a laparoscopic or robotic approach. Data collected included patient demographics, operative variables, and 30-day postoperative outcomes.

Results

A total of 132 patients had a minimally invasive IPAA; 58 were performed laparoscopically and 74 robotically. Less than half the patients were female (n = 55; 41.7%) with a median age of 37 years (range 18–68 years). The majority of patients had a diagnosis of ulcerative colitis (n = 103; 78.0%) with medically refractory disease (n = 87; 65.9%). A greater proportion of patients in the laparoscopic cohort had a prolonged length of stay (n = 27; 46.6% versus n = 18; 24.3%; p < 0.001) and a two-stage approach (n = 56; 96.6% versus n = 37; 50%; p < 0.001), but there were no differences in the rates between the laparoscopic versus robotic cohorts of superficial surgical site infection (6.9% versus 6.8%; p = 0.99), peripouch abscess (15.5% versus 6.8%; p = 0.11), anastomotic leak (6.9% versus 2.7%; p = 0.21), pelvic abscess (15.5% versus 6.8%; p = 0.11), and pelvic sepsis (15.5% versus 6.8%; p = 0.11), readmission (24.1% versus 17.6%; p = 0.35) or reoperation (6.9% versus 5.4%; p = 0.72). On multivariable analysis, only male sex remained predictive of prolonged length of stay, and a robotic approach trended toward a decreased rate of prolonged length of stay.

Conclusions

Laparoscopic and robotic IPAA have equivalent postoperative morbidity underscoring the safety of the continued expansion of the robotic platform for pouch surgery.

Keywords

Ileal pouch-anal anastomosis Proctocolectomy Restorative Minimally invasive surgery Robotic surgical procedures 

Notes

Author contributions

All authors meet the three authorship criteria: substantial contribution, participation in drafting the article, and final approval.

Funding

There are no sources of funding.

Compliance with ethical standards

Conflict of interest

Amy Lightner receives consultant fees from Takeda; all other authors: declare that they have no conflict of interest.

Ethical approval

All human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki.

Informed consent

For this type of study, informed consent was not necessary.

References

  1. 1.
    Fazio VW, Ziv Y, Church JM et al (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222(2):120–127CrossRefGoogle Scholar
  2. 2.
    Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2(6130):85–88CrossRefGoogle Scholar
  3. 3.
    Perdawood SK, Al Khefagie GA (2016) Transanal vs laparoscopic total mesorectal excision for rectal cancer: initial experience from Denmark. Colorectal Dis 18(1):51–58CrossRefGoogle Scholar
  4. 4.
    Perdawood SK, Thinggaard BS, Bjoern MX (2018) Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc 32(5):2312–2321CrossRefGoogle Scholar
  5. 5.
    Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP (2016) A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 18(1):19–36CrossRefGoogle Scholar
  6. 6.
    Larson DW, Cima RR, Dozois EJ et al (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243(5):667–670 (discussion 670–662) CrossRefGoogle Scholar
  7. 7.
    White I, Jenkins JT, Coomber R, Clark SK, Phillips RK, Kennedy RH (2014) Outcomes of laparoscopic and open restorative proctocolectomy. Br J Surg 101(9):1160–1165CrossRefGoogle Scholar
  8. 8.
    Ahmed Ali U, Keus F, Heikens JT et al (2009) Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD006267.pub2 Google Scholar
  9. 9.
    Bartels SA, D’Hoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA (2012) Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 256(6):1045–1048CrossRefGoogle Scholar
  10. 10.
    Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y (2013) A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 258(2):275–282CrossRefGoogle Scholar
  11. 11.
    Baek SJ, Dozois EJ, Mathis KL et al (2016) Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience. Tech Coloproctol 20(6):369–374CrossRefGoogle Scholar
  12. 12.
    de Buck van Overstraeten A, Mark-Christensen A, Wasmann KA et al (2017) Transanal versus transabdominal minimally invasive (completion) proctectomy with ileal pouch-anal anastomosis in ulcerative colitis: a comparative study. Ann Surg 266(5):878–883CrossRefGoogle Scholar
  13. 13.
    Mark-Christensen A, Pachler FR, Norager CB, Jepsen P, Laurberg S, Tottrup A (2016) Short-term outcome of robot-assisted and open IPAA: an observational single-center study. Dis Colon Rectum 59(3):201–207CrossRefGoogle Scholar
  14. 14.
    Miller AT, Berian JR, Rubin M, Hurst RD, Fichera A, Umanskiy K (2012) Robotic-assisted proctectomy for inflammatory bowel disease: a case-matched comparison of laparoscopic and robotic technique. J Gastrointest Surg 16(3):587–594CrossRefGoogle Scholar
  15. 15.
    Roviello F, Piagnerelli R, Ferrara F, Scheiterle M, De Franco L, Marrelli D (2015) Robotic single docking total colectomy for ulcerative colitis: First experience with a novel technique. Int J Surg 21:63–67CrossRefGoogle Scholar
  16. 16.
    Yang Y, Wang F, Zhang P et al (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19(12):3727–3736CrossRefGoogle Scholar
  17. 17.
    Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching. JAMA Surg 149(2):177–184CrossRefGoogle Scholar
  18. 18.
    Trinh BB, Jackson NR, Hauch AT, Hu T, Kandil E (2015) Robotic versus laparoscopic colorectal surgery. J Soc Laparoendosc Surg 18(4):e2014.00187.  https://doi.org/10.4293/JSLS.2014.00187 CrossRefGoogle Scholar
  19. 19.
    Kim MJ, Park SC, Park JW et al (2018) Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 267(2):243–251CrossRefGoogle Scholar
  20. 20.
    Tyler JA, Fox JP, Desai MM, Perry WB, Glasgow SC (2013) Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rectum 56(4):458–466CrossRefGoogle Scholar
  21. 21.
    Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21(10):1701–1708CrossRefGoogle Scholar
  22. 22.
    Bertani E, Chiappa A, Biffi R et al (2011) Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches. Int J Colorectal Dis 26(10):1317–1327CrossRefGoogle Scholar
  23. 23.
    Zhang H, Hu S, Zhang G et al (2007) Laparoscopic versus open proctocolectomy with ileal pouch-anal anastomosis. Minim Invasive Ther Allied Technol 16(3):187–191CrossRefGoogle Scholar
  24. 24.
    Fajardo AD, Dharmarajan S, George V et al (2010) Laparoscopic versus open 2-stage ileal pouch: laparoscopic approach allows for faster restoration of intestinal continuity. J Am Coll Surg 211(3):377–383CrossRefGoogle Scholar
  25. 25.
    Duff SE, Sagar PM, Rao M, Macafee D, El-Khoury T (2012) Laparoscopic restorative proctocolectomy: safety and critical level of the ileal pouch anal anastomosis. Colorectal Dis 14(7):883–886CrossRefGoogle Scholar
  26. 26.
    Mak TW, Lee JF, Futaba K, Hon SS, Ngo DK, Ng SS (2014) Robotic surgery for rectal cancer: a systematic review of current practice. World J Gastrointest Oncol 6(6):184–193CrossRefGoogle Scholar
  27. 27.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefGoogle Scholar
  28. 28.
    Jayne D, Pigazzi A, Marshall H et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580CrossRefGoogle Scholar
  29. 29.
    Lacy AM, Delgado S, Castells A et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248(1):1–7CrossRefGoogle Scholar
  30. 30.
    Ross H, Steele SR, Varma M et al (2014) Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 57(1):5–22CrossRefGoogle Scholar
  31. 31.
    Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP (2012) Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 55(4):387–392CrossRefGoogle Scholar
  32. 32.
    Selvaggi F, Sciaudone G, Limongelli P et al (2010) The effect of pelvic septic complications on function and quality of life after ileal pouch-anal anastomosis: a single center experience. Am Surg 76(4):428–435Google Scholar
  33. 33.
    Heuschen UA, Allemeyer EH, Hinz U, Lucas M, Herfarth C, Heuschen G (2002) Outcome after septic complications in J pouch procedures. Br J Surg 89(2):194–200Google Scholar
  34. 34.
    Leo CA, Samaranayake S, Perry-Woodford ZL et al (2016) Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Colorectal Dis 18(12):1162–1166CrossRefGoogle Scholar
  35. 35.
    Rencuzogullari A, Gorgun E, Costedio M et al (2016) Case-matched comparison of robotic versus laparoscopic proctectomy for inflammatory bowel disease. Surg Laparosc Endosc Percutan Tech 26(3):e37–e40CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • A. L. Lightner
    • 1
    • 3
    Email author
  • F. Grass
    • 1
  • N. P. McKenna
    • 1
  • M. Tilman
    • 1
  • A. Alsughayer
    • 1
  • S. R. Kelley
    • 1
  • K. Behm
    • 1
  • A. Merchea
    • 2
  • D. W. Larson
    • 1
  1. 1.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Colon and Rectal SurgeryMayo ClinicJacksonvilleUSA
  3. 3.Colorectal SurgeryCleveland ClinicClevelandUSA

Personalised recommendations