Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent

Amy Lightner, F. Grass, N. P. McKenna, M. Tilman, A. Alsughayer, S. R. Kelley, K. Behm, A. Merchea, David Larson

Research output: Contribution to journalArticle

Abstract

Background: Minimally invasive approaches have become the standard of care for ileal pouch-anal anastomoses (IPAA). There are few reports comparing outcomes following a laparoscopic versus robotic approach. Our aim was to determine if there were any differences in the 30-day postoperative outcomes following IPAA performed laparoscopically versus robotically. Methods: A retrospective chart review of all laparoscopic and robotic IPAA performed between January 1, 2015 and June 30, 2018 was carried out. Patients included were adult patients who underwent a proctectomy and IPAA utilizing either a laparoscopic or robotic approach. Data collected included patient demographics, operative variables, and 30-day postoperative outcomes. Results: A total of 132 patients had a minimally invasive IPAA; 58 were performed laparoscopically and 74 robotically. Less than half the patients were female (n = 55; 41.7%) with a median age of 37 years (range 18–68 years). The majority of patients had a diagnosis of ulcerative colitis (n = 103; 78.0%) with medically refractory disease (n = 87; 65.9%). A greater proportion of patients in the laparoscopic cohort had a prolonged length of stay (n = 27; 46.6% versus n = 18; 24.3%; p < 0.001) and a two-stage approach (n = 56; 96.6% versus n = 37; 50%; p < 0.001), but there were no differences in the rates between the laparoscopic versus robotic cohorts of superficial surgical site infection (6.9% versus 6.8%; p = 0.99), peripouch abscess (15.5% versus 6.8%; p = 0.11), anastomotic leak (6.9% versus 2.7%; p = 0.21), pelvic abscess (15.5% versus 6.8%; p = 0.11), and pelvic sepsis (15.5% versus 6.8%; p = 0.11), readmission (24.1% versus 17.6%; p = 0.35) or reoperation (6.9% versus 5.4%; p = 0.72). On multivariable analysis, only male sex remained predictive of prolonged length of stay, and a robotic approach trended toward a decreased rate of prolonged length of stay. Conclusions: Laparoscopic and robotic IPAA have equivalent postoperative morbidity underscoring the safety of the continued expansion of the robotic platform for pouch surgery.

Original languageEnglish (US)
JournalTechniques in Coloproctology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Colonic Pouches
Robotics
Length of Stay
Abscess
Surgical Wound Infection
Anastomotic Leak
Standard of Care
Reoperation
Ulcerative Colitis
Sepsis
Demography
Morbidity
Safety

Keywords

  • Ileal pouch-anal anastomosis
  • Minimally invasive surgery
  • Proctocolectomy
  • Restorative
  • Robotic surgical procedures

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent. / Lightner, Amy; Grass, F.; McKenna, N. P.; Tilman, M.; Alsughayer, A.; Kelley, S. R.; Behm, K.; Merchea, A.; Larson, David.

In: Techniques in Coloproctology, 01.01.2019.

Research output: Contribution to journalArticle

Lightner, Amy ; Grass, F. ; McKenna, N. P. ; Tilman, M. ; Alsughayer, A. ; Kelley, S. R. ; Behm, K. ; Merchea, A. ; Larson, David. / Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent. In: Techniques in Coloproctology. 2019.
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abstract = "Background: Minimally invasive approaches have become the standard of care for ileal pouch-anal anastomoses (IPAA). There are few reports comparing outcomes following a laparoscopic versus robotic approach. Our aim was to determine if there were any differences in the 30-day postoperative outcomes following IPAA performed laparoscopically versus robotically. Methods: A retrospective chart review of all laparoscopic and robotic IPAA performed between January 1, 2015 and June 30, 2018 was carried out. Patients included were adult patients who underwent a proctectomy and IPAA utilizing either a laparoscopic or robotic approach. Data collected included patient demographics, operative variables, and 30-day postoperative outcomes. Results: A total of 132 patients had a minimally invasive IPAA; 58 were performed laparoscopically and 74 robotically. Less than half the patients were female (n = 55; 41.7{\%}) with a median age of 37 years (range 18–68 years). The majority of patients had a diagnosis of ulcerative colitis (n = 103; 78.0{\%}) with medically refractory disease (n = 87; 65.9{\%}). A greater proportion of patients in the laparoscopic cohort had a prolonged length of stay (n = 27; 46.6{\%} versus n = 18; 24.3{\%}; p < 0.001) and a two-stage approach (n = 56; 96.6{\%} versus n = 37; 50{\%}; p < 0.001), but there were no differences in the rates between the laparoscopic versus robotic cohorts of superficial surgical site infection (6.9{\%} versus 6.8{\%}; p = 0.99), peripouch abscess (15.5{\%} versus 6.8{\%}; p = 0.11), anastomotic leak (6.9{\%} versus 2.7{\%}; p = 0.21), pelvic abscess (15.5{\%} versus 6.8{\%}; p = 0.11), and pelvic sepsis (15.5{\%} versus 6.8{\%}; p = 0.11), readmission (24.1{\%} versus 17.6{\%}; p = 0.35) or reoperation (6.9{\%} versus 5.4{\%}; p = 0.72). On multivariable analysis, only male sex remained predictive of prolonged length of stay, and a robotic approach trended toward a decreased rate of prolonged length of stay. Conclusions: Laparoscopic and robotic IPAA have equivalent postoperative morbidity underscoring the safety of the continued expansion of the robotic platform for pouch surgery.",
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T1 - Short-term postoperative outcomes following robotic versus laparoscopic ileal pouch-anal anastomosis are equivalent

AU - Lightner, Amy

AU - Grass, F.

AU - McKenna, N. P.

AU - Tilman, M.

AU - Alsughayer, A.

AU - Kelley, S. R.

AU - Behm, K.

AU - Merchea, A.

AU - Larson, David

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Minimally invasive approaches have become the standard of care for ileal pouch-anal anastomoses (IPAA). There are few reports comparing outcomes following a laparoscopic versus robotic approach. Our aim was to determine if there were any differences in the 30-day postoperative outcomes following IPAA performed laparoscopically versus robotically. Methods: A retrospective chart review of all laparoscopic and robotic IPAA performed between January 1, 2015 and June 30, 2018 was carried out. Patients included were adult patients who underwent a proctectomy and IPAA utilizing either a laparoscopic or robotic approach. Data collected included patient demographics, operative variables, and 30-day postoperative outcomes. Results: A total of 132 patients had a minimally invasive IPAA; 58 were performed laparoscopically and 74 robotically. Less than half the patients were female (n = 55; 41.7%) with a median age of 37 years (range 18–68 years). The majority of patients had a diagnosis of ulcerative colitis (n = 103; 78.0%) with medically refractory disease (n = 87; 65.9%). A greater proportion of patients in the laparoscopic cohort had a prolonged length of stay (n = 27; 46.6% versus n = 18; 24.3%; p < 0.001) and a two-stage approach (n = 56; 96.6% versus n = 37; 50%; p < 0.001), but there were no differences in the rates between the laparoscopic versus robotic cohorts of superficial surgical site infection (6.9% versus 6.8%; p = 0.99), peripouch abscess (15.5% versus 6.8%; p = 0.11), anastomotic leak (6.9% versus 2.7%; p = 0.21), pelvic abscess (15.5% versus 6.8%; p = 0.11), and pelvic sepsis (15.5% versus 6.8%; p = 0.11), readmission (24.1% versus 17.6%; p = 0.35) or reoperation (6.9% versus 5.4%; p = 0.72). On multivariable analysis, only male sex remained predictive of prolonged length of stay, and a robotic approach trended toward a decreased rate of prolonged length of stay. Conclusions: Laparoscopic and robotic IPAA have equivalent postoperative morbidity underscoring the safety of the continued expansion of the robotic platform for pouch surgery.

AB - Background: Minimally invasive approaches have become the standard of care for ileal pouch-anal anastomoses (IPAA). There are few reports comparing outcomes following a laparoscopic versus robotic approach. Our aim was to determine if there were any differences in the 30-day postoperative outcomes following IPAA performed laparoscopically versus robotically. Methods: A retrospective chart review of all laparoscopic and robotic IPAA performed between January 1, 2015 and June 30, 2018 was carried out. Patients included were adult patients who underwent a proctectomy and IPAA utilizing either a laparoscopic or robotic approach. Data collected included patient demographics, operative variables, and 30-day postoperative outcomes. Results: A total of 132 patients had a minimally invasive IPAA; 58 were performed laparoscopically and 74 robotically. Less than half the patients were female (n = 55; 41.7%) with a median age of 37 years (range 18–68 years). The majority of patients had a diagnosis of ulcerative colitis (n = 103; 78.0%) with medically refractory disease (n = 87; 65.9%). A greater proportion of patients in the laparoscopic cohort had a prolonged length of stay (n = 27; 46.6% versus n = 18; 24.3%; p < 0.001) and a two-stage approach (n = 56; 96.6% versus n = 37; 50%; p < 0.001), but there were no differences in the rates between the laparoscopic versus robotic cohorts of superficial surgical site infection (6.9% versus 6.8%; p = 0.99), peripouch abscess (15.5% versus 6.8%; p = 0.11), anastomotic leak (6.9% versus 2.7%; p = 0.21), pelvic abscess (15.5% versus 6.8%; p = 0.11), and pelvic sepsis (15.5% versus 6.8%; p = 0.11), readmission (24.1% versus 17.6%; p = 0.35) or reoperation (6.9% versus 5.4%; p = 0.72). On multivariable analysis, only male sex remained predictive of prolonged length of stay, and a robotic approach trended toward a decreased rate of prolonged length of stay. Conclusions: Laparoscopic and robotic IPAA have equivalent postoperative morbidity underscoring the safety of the continued expansion of the robotic platform for pouch surgery.

KW - Ileal pouch-anal anastomosis

KW - Minimally invasive surgery

KW - Proctocolectomy

KW - Restorative

KW - Robotic surgical procedures

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