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Comparison of Robotic versus Single-Port Laparoscopic Completion Proctectomy with IPAA for Ulcerative Colitis
Ahmet Rencuzogullari, Cigdem Benlice*, Meagan Costedio, Hermann Kessler, Jean Ashburn, Luca Stocchi, Emre Gorgun
Cleveland Clinic, Cleveland, OH
Background: Single-incision laparoscopic surgery (SILS) through the predetermined ostomy site without additional trocar sites has been successfully applied in completion proctectomy (CP) with ileal-pouch anal anastomosis (IPAA) procedure in ulcerative colitis (UC). Robotic CP with IPAA has recently being increasingly utilized especially during early learning period of surgeons due to benign nature of the disease. The aim of this study was to compare short-term outcomes of robotic and single-port laparoscopic CP with IPAA for patients with UC.
Methods: Patients who underwent either robotic-CP or SILS-CP with IPAA for UC between 01/2009 and 11/2015 were identified from an IRB-approved, prospectively maintained institutional database and reviewed. The decision on whether to perform robotic-CP or SILS-CP was made by the operating surgeon that was mainly based on ability to perform procedure and availability of robotic platform. Demographics, patient characteristics and short-term complications were compared between robotic-CP and SILS-CP groups. Multivariate logistic regression analysis was conducted for covariate adjustments.
Results: A total of 84 patients were identified during the study period with a mean age of 40 (±15) years [40 (48%) female]. There were 29 (34.5%) patients in robotic-CP and 55 (65.5%) in SILS-CP group. Groups were comparable in terms of preoperative characteristics and demographics except age (45±15 vs. 37±14 years, p=0.04) and gender [6 (20.7%) vs. 34 (61.8%) for female, p=0.001]. Conversion to open rates were comparable between robotic-CP and SILS-CP groups [3 (10.3%) vs. 2 (3.7%), p=0.34]. Robotic-CP was associated with increased estimated blood loss (297±214 vs. 125±121, p<0.001), longer operating time (323±91 vs. 202±64 minutes, p<0.001), and longer length of stay (LOS) (5.6±2.6 vs. 5.0±3.2, p=0.03) compared to SILS-CP. Overall morbidity (37.9% vs 30.9%, p=0.59), postoperative ileus (27.6% vs. 10.9%, p=0.07), and readmission rates (17.2% vs. 14.5%, p=0.76) were comparable between the groups. After multivariate analysis adjusting for age and gender, the differences in the outcomes between the groups remained same except LOS (p=0.46) (Table).
Conclusion: Single-incision laparoscopic surgery for completion proctectomy in ileal-pouch anal anastomosis seems to offer superior short-term outcomes compared to robotic approach. Robotic completion proctectomy in selected patients with ulcerative colitis helps surgeons during their early learning period.
Table. Results of multivariate logistic regression modeling for the association between outcomes and type of surgery
| Outcome | Multivariate MR or OR | 95% Confidence Interval | P-value | | Length of stay | 1.106 | 0.847 - 1.445 | 0.46 | | Operative time | 1.541 | 1.333 - 1.783 | <0.001 | | Estimated blood loss | 1.707 | 1.165 - 2.501 | 0.007 | | Morbidity | 1.195 | 0.416 - 3.430 | 0.74 | | Postoperative ileus | 3.494 | 0.916 - 13.332 | 0.07 | | Readmission | 1.057 | 0.271 - 4.126 | 0.94 |
Median Ratios (MR) (for operative time, length of hospital stay and estimated blood loss) and Odds Ratios (OR) (for dichotomous outcomes) are reported for Robotic-completion proctectomy relative to single-incisional laparoscopic-completion proctectomy.
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