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Background <p>Laparoscopic and robotic-assisted approaches are increasingly used for ileal pouch-anal anastomosis (IPAA) after restorative proctocolectomy, yet direct comparisons of short-term outcomes are limited. This systematic review compared&#xa0;the collective short-term outcomes of laparoscopic and robotic-assisted IPAA.</p> Methods <p>A&#xa0;PRISMA-compliant systematic review of PubMed, Scopus, and Cochrane Library was performed (January 2000–June 2025) to identify studies comparing robotic-assisted and laparoscopic IPAA. The primary outcome was 30-day complications and conversion&#xa0;to open surgery. Pairwise meta-analyses and random-effects meta-regression were conducted. The risk of bias was assessed using ROBINS-1 tool; evidence certainty was examined using GRADE.</p> Results <p>8 cohort studies, comprising 1861 patients, were included. 1241 patients (66.7%) underwent laparoscopic IPAA, 620 (33.3%) underwent robotic-assisted IPAA. There were no significant differences in the odds of total (OR 0.97, 95%CI 0.66, 1.41, <i>p</i> = 0.855) or major complications (OR 1.11, 95%CI 0.81, 1.53, <i>p</i> = 0.511). Odds of ileus, small bowel obstruction, and anastomotic leak were comparable. Robotic-assisted IPAA was associated with significantly fewer conversions to open surgery (OR 0.25, 95%CI 0.08, 0.77, <i>p</i> = 0.015) but longer operative times (WMD 24.97, 95%CI 2.09, 47.85, <i>p</i> = 0.032). Blood loss and intraoperative complications did not significantly differ. Meta-regression showed the conversion benefit of robotic IPAA was more pronounced in male patients and those with higher ASA, ulcerative colitis, and 3-stage IPAA.</p> Conclusions <p>Robotic-assisted and laparoscopic IPAA have comparable short-term complication rates, with robotic-assisted surgery offering significantly lower risk of conversion but longer operative times. These findings confirm robotic-assisted IPAA is an acceptable alternative to laparoscopic IPAA; however, interpretation should be cautious given the observational design&#xa0;of the studies and overall low certainty of evidence.&#xa0;Surgeon expertise in technique and resource availability will influence operative approach.</p> Graphical abstract <p></p>

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Short-term surgical outcomes of robotic-assisted versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • James Burns,
  • Abel Abraham,
  • Sameh Hany Emile,
  • Samantha Sipe,
  • Christopher Lopez,
  • Lillian Wagner,
  • Anjelli Wignakumar,
  • Steven D. Wexner

摘要

Background

Laparoscopic and robotic-assisted approaches are increasingly used for ileal pouch-anal anastomosis (IPAA) after restorative proctocolectomy, yet direct comparisons of short-term outcomes are limited. This systematic review compared the collective short-term outcomes of laparoscopic and robotic-assisted IPAA.

Methods

A PRISMA-compliant systematic review of PubMed, Scopus, and Cochrane Library was performed (January 2000–June 2025) to identify studies comparing robotic-assisted and laparoscopic IPAA. The primary outcome was 30-day complications and conversion to open surgery. Pairwise meta-analyses and random-effects meta-regression were conducted. The risk of bias was assessed using ROBINS-1 tool; evidence certainty was examined using GRADE.

Results

8 cohort studies, comprising 1861 patients, were included. 1241 patients (66.7%) underwent laparoscopic IPAA, 620 (33.3%) underwent robotic-assisted IPAA. There were no significant differences in the odds of total (OR 0.97, 95%CI 0.66, 1.41, p = 0.855) or major complications (OR 1.11, 95%CI 0.81, 1.53, p = 0.511). Odds of ileus, small bowel obstruction, and anastomotic leak were comparable. Robotic-assisted IPAA was associated with significantly fewer conversions to open surgery (OR 0.25, 95%CI 0.08, 0.77, p = 0.015) but longer operative times (WMD 24.97, 95%CI 2.09, 47.85, p = 0.032). Blood loss and intraoperative complications did not significantly differ. Meta-regression showed the conversion benefit of robotic IPAA was more pronounced in male patients and those with higher ASA, ulcerative colitis, and 3-stage IPAA.

Conclusions

Robotic-assisted and laparoscopic IPAA have comparable short-term complication rates, with robotic-assisted surgery offering significantly lower risk of conversion but longer operative times. These findings confirm robotic-assisted IPAA is an acceptable alternative to laparoscopic IPAA; however, interpretation should be cautious given the observational design of the studies and overall low certainty of evidence. Surgeon expertise in technique and resource availability will influence operative approach.

Graphical abstract