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IS ROBOTIC ILEOCOLIC RESECTION FOR CROHN's DISEASE AS SAFE AS LAPAROSCOPY?
H. Hande Aydinli^*, Hasan T. Kirat, Alexis Grucela, Michael Grieco, Feza H. Remzi
Department of Surgery, New York University, New York, NY
Background: The aim of this study was to investigate the adoption of robotic ileocolic resection for CD in a nationwide database and compare the operative and postoperative outcomes between robotic and laparoscopic approach.

Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database participant user files (2012-2015) was queried for all patients who underwent ileocolic resection for Crohn's disease using the ICD and CPT codes. Demographics, comorbidities, operative and postoperative outcomes were compared between robotic and laparoscopic groups.

Results: A total of 1658 patients were identified with a mean age of 38.1 (SD: ±14.7) (female 54%). Forty-seven patients underwent robotic surgery (3%). Patient demographics and comorbidities were comparable between the groups except age [Robotic (R): 32.8± 13.7 vs. Laparoscopic (L): 38.3± 14.7, p=0.005]. Conversion rate was lower in the robotic group (R: 6.3%), and twice as high in the laparoscopic cohort (L: 13.1%), although it did not meet statistical significance (p=0.1). 429 patients (25.3%) had postoperative complications (R: 27.6% vs. L: 25.2%, p=0.7) and 3 laparoscopic patients (0.1%) (R: 0% vs. L: 0.1%, p=0.7) died within 30 days of surgery. The most common postoperative complication was ileus (n: 185, 11.1%; R: 14.8%, L: 11.0% p=0.4) followed by organ-space surgical site infection (n: 92, 5.5%; R: 6.3%, L: 5.5% p=0.8) and need for transfusion (n: 84, 5.1%; R: 4.2%. L: 5.0% p=0.7). Operative time was slightly longer in robotic group (179.4 min ± 62.9 vs. 155.1 min ± 62.1, p=0.002). Mean length of stay was 1 day shorter in the robotic group, but this did not meet statistical significance(R: 5.5 days ±3.1 vs. L: 6.5 days ±6.1, p=0.5). Reoperation rate was 4.0% in laparoscopic group versus 4.2% in robotic (p=0.9) within 30 days of surgery.
9.7% of all patients were readmitted within 30-days of surgery and this was comparable between the groups (p=0.2).

Conclusion: Robotic ileocolic resection is as safe as the laparoscopic approach in the setting of Crohn's disease. The robotic approach has similar complications and less mortality. The lower conversion rate in robotic resection maybe due to technical advantages of the robot in handling the challenging mesentery in Crohn's disease.

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