Robotic Surgery for Inflammatory Bowel Diseases and Total Colectomy

Surgery represents the mainstay of treatment for inflammatory bowel diseases (IBD). In recent decades, a minimally invasive approach has been pursued in this area, especially for uncomplicated cases, and this has resulted in better postoperative recovery, less postoperative pain, shorter hospitalization, quicker return to bowel function and, above all, prevention of abdominal adhesions. The last decade has been marked by the growing use of robotic surgery in IBD and robotic technology may provide an interesting alternative to conventional laparoscopy in challenging procedures, such as stricturoplasty for Crohn’s disease or total colectomy or proctocolectomy for ulcerative colitis. However, high costs, longer operative time due to multiple dockings and low availability represent the most important drawbacks of robotic technology. The shortage of literature on this surgery, which is performed in specialized high-volume centers in selected cases, entails a lack of high-grade evidence. The lower conversion rate compared to laparoscopy is one of the main reported advantages. The new robotic devices have reduced the time required for the docking steps. Long-term outcomes – such as bowel and genitourinary function, incisional hernias, quality of life, and small bowel obstructions secondary to adhesions – have not been adequately investigated in this generally young population. Randomized controlled trials analyzing these outcomes and the cost-effectiveness of robotic surgery are needed.