Implementation of a robotic surgical practice in inflammatory bowel disease

Abstract

Abstract Background Robotics adoption has increased in colorectal surgery. While there are well-established advantages and standardised techniques for cancer patients, the use of robotic surgery in inflammatory bowel disease (IBD) hasn’t been studied yet. Objective To evaluate the feasibility and safety of robotic surgery for IBD patients. Methods Prospectively data in IBD patients having robotic resection at Guy’s and St Thomas’ hospital. All resections performed by a single colorectal surgeon specialised in IBD, utilising Da-Vinci platform. Results July 2021 to January 2023, 59 robotic IBD cases performed, 14 ulcerative colitis (UC) and 45 Crohn’s disease (CD). Average age; CD patients 35, UC 33 years. Average Body mass index (BMI); 23 for CD and 26.9 for UC patients. In total, we performed 31 ileo-caecal resections (ICR) with primary anastomosis (18 Kono-S anastomosis, 6 mechanical anastomosis and 7 ileo-colostomy), of those 4 had multivisceral resections (large bowel, bladder, ovary). Furthermore, 14 subtotal colectomy (1 emergency), 8 proctectomy, 3 panproctocolectomy and 3 ileo-anal J pouch. 18 of the 45 patients (45.0%) with crohn’s disease had ongoing fistulating disease to other parts of the GI tract (small or large bowel). ICR were performed using different 3 ports position, depending on the anatomy established prior to surgery with magnetic resonance images (MRI). One patient had conversion to open due to anaesthetic problems and one patient required re-operation to refashion stoma. 98.0% cases completed robotically. Median Length of hospital stay (LOS) was 7 days for CD and 7 for UC cases, including LOS in patients on pre-operative parenteral nutrition. Conclusions Robotic colorectal techniques can be safely used for patients with IBD, even with fistulating disease. Future research and collaborations are necessary to standardize technique within institutions.