Short-term Outcome of Robot-assisted and Open IPAA

Mark‐Christensen, Anders; Pachler, Frederik Rønne; Nørager, Charlotte Buchard; Jepsen, Peter; Laurberg, Søren; Tøttrup, Anders P.

doi:10.1097/dcr.0000000000000540

Cited by 36 publications

(48 citation statements)

References 29 publications

(18 reference statements)

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“…There is promise, however, in the low short-term postoperative morbidity after minimally invasive surgery. Mark-Christensen et al reported that the readmission rate was higher in those who had robotic IPAA compared to open (40% vs 26%); however, the length of hospital stay was significantly shorter [6].…”

Section: Discussionmentioning

confidence: 99%

“…Schiessling et al evaluated the short-term outcomes of laparoscopic and open IPAA and have demonstrated no significant advantages for laparoscopy, except for cosmetic satisfaction. The conversion rate from laparoscopic to open approach was 23.8%, and the study appears to be underpowered due to the low number of patients [6,7]. Subsequently, Benlice et al demonstrated that when IPAA is done laparoscopically the incidence of incisional hernia is not diminished compared to an open group (8.4% vs 5.9%; P = 0.40).…”

Section: Discussionmentioning

confidence: 99%

“…Now, IPAA is most commonly performed using a J pouch design, with a double stapled anastomosis and sometimes omission of the loop ileostomy [3][4][5]. The surgical approach now includes laparoscopic, laparoscopic with hand assist, open, and even robotic techniques [6][7][8]. Indications for the procedure have expanded from MUC and FAP to include CD, and functional bowel disorders [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care

et al. 2017

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Aim Surgical technique constantly evolves in response to the pressure of progress. Ileal pouch anal anastomosis (IPAA) is a good example. We analysed the effect of changes in practice on the technique of IPAA and its outcomes. Method Patients undergoing primary IPAA at this institution were divided into three groups by date of the IPAA: those operated from 1983 to 1993, from 1994 to 2004 and from 2005 to 2015. Demographics, patient comorbidity, surgical techniques, postoperative outcomes, pouch function and quality of life were analysed. Results In all, 4525 patients had a primary IPAA. With each decade, increasing numbers of surgeons were involved (decade I, 8; II, 16; III, 31), patients tended to be sicker (higher American Society of Anesthesiologists score) and three‐staged pouches became more common. After an initial popularity of the S pouch, J pouches became dominant and a mucosectomy rate of 12% was standard. The laparoscopic technique blossomed in the last decade. 90‐day postoperative morbidity by decade was 38.3% vs 50% vs 48% (P < 0.0001), but late morbidity decreased from 74.2% through 67.1% to 30% (P < 0.0001). Functional results improved, but quality of life scores did not. Pouch survival rate at 10 years was maintained (94% vs 95.2% vs 95.2%; P = 0.06). Conclusion IPAA is still evolving. Despite new generations of surgeons, a more accurate diagnosis, appropriate staging and the laparoscopic technique have made IPAA a safer, more effective and enduring operation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care

et al. 2017

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“…colectomy ± lap. double-stapled IPAA + end ileostomy 4 robotic arms (camera port at the superior portion of umbilicus), assistant port in RUQ Single NR Period 1 293.2 ± 95.7 vs. Period 2 264.7 ± 93.6 Mark-Christensen et al [ 17 ] Aarhus, Denmark 2016 Jan. 2004–Sept. 2014 81 Control = 170 UC CMOR 5 Robotic completion proctectomy ± lap colectomy ( n = 2; the remaining 79 had previously undergone lap.…”

Section: Resultsmentioning

confidence: 99%

Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review

et al. 2018

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The purpose of this study was to assess outcome measures and cost-effectiveness of robotic colorectal resections in adult patients with inflammatory bowel disease. The Cochrane Library, PubMed/Medline and Embase databases were reviewed, using the text “robotic(s)” AND (“inflammatory bowel disease” OR “Crohn’s” OR “Ulcerative Colitis”). Two investigators screened abstracts for eligibility. All English language full-text articles were reviewed for specified outcomes. Data were presented in a summarised and aggregate form, since the lack of higher-level evidence studies precluded meta-analysis. Primary outcomes included mortality and postoperative complications. Secondary outcomes included readmission rate, length of stay, conversion rate, procedure time, estimated blood loss and functional outcome. The tertiary outcome was cost-effectiveness. Eight studies (3 case-matched observational studies, 4 case series and 1 case report) met the inclusion criteria. There was no reported mortality. Overall, complications occurred in 81 patients (54%) including 30 (20%) Clavien-Dindo III–IV complications. Mean length of stay was 8.6 days. Eleven cases (7.3%) were converted to open. The mean robotic operating time was 99 min out of a mean total operating time of 298.6 min. Thirty-two patients (24.7%) were readmitted. Functional outcomes were comparable among robotic, laparoscopic and open approaches. Case-matched observational studies comparing robotic to laparoscopic surgery revealed a significantly longer procedure time; however, conversion, complication, length of stay and readmission rates were similar. The case-matched observational study comparing robotic to open surgery also revealed a longer procedure time and a higher readmission rate; postoperative complication rates and length of stay were similar. No studies compared cost-effectiveness between robotic and traditional approaches. Although robotic resections for inflammatory bowel disease are technically feasible, outcomes must be interpreted with caution due to low-quality studies.

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“…Regarding colectomy only, the evidence for a laparoscopic approach is slightly stronger (see Section 4). Robot-assisted pouch procedures appear to offer acceptable short-term outcomes but there is no highquality evidence to suggest superior outcomes compared with existing techniques [350]. Similarly, SILS [351] and natural orifice specimen extraction techniques [352] have been described but require further investigation before recommendation.…”

Section: Laparoscopic Pouch Formation Robotics Sils and Natural Orimentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

et al. 2018

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Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. Results All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

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Short-term Outcome of Robot-assisted and Open IPAA

Abstract: 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.

Cited by 36 publications

References 29 publications

Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care

Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care

Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

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