Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
J Crohns Colitis. 2024 Aug 14;18(8):1342-1355. doi: 10.1093/ecco-jcc/jjae037.
We aimed to evaluate outcomes of robotic versus conventional laparoscopic colorectal resections in patients with inflammatory bowel disease [IBD].
Comparative studies of robotic versus laparoscopic colorectal resections in patients with IBD were included. The primary outcome was total post-operative complication rate. Secondary outcomes included operative time, conversion to open surgery, anastomotic leaks, intra-abdominal abscess formation, ileus occurrence, surgical site infection, re-operation, re-admission rate, length of hospital stay, and 30-day mortality. Combined overall effect sizes were calculated using a random-effects model and the Newcastle-Ottawa Scale was used to assess risk of bias.
Eleven non-randomized studies [n = 5566 patients] divided between those undergoing robotic [n = 365] and conventional laparoscopic [n = 5201] surgery were included. Robotic platforms were associated with a significantly lower overall post-operative complication rate compared with laparoscopic surgery [p = 0.03]. Laparoscopic surgery was associated with a significantly shorter operative time [p = 0.00001]. No difference was found in conversion rates to open surgery [p = 0.15], anastomotic leaks [p = 0.84], abscess formation [p = 0.21], paralytic ileus [p = 0.06], surgical site infections [p = 0.78], re-operation [p = 0.26], re-admission rate [p = 0.48], and 30-day mortality [p = 1.00] between the groups. Length of hospital stay was shorter following a robotic sub-total colectomy compared with conventional laparoscopy [p = 0.03].
Outcomes in the surgical management of IBD are comparable between traditional laparoscopic techniques and robotic-assisted minimally invasive surgery, demonstrating the safety and feasibility of robotic platforms. Larger studies investigating the use of robotic technology in Crohn's disease and ulcerative colitis separately may be of benefit with a specific focus on important IBD-related metrics.
我们旨在评估机器人与传统腹腔镜结直肠切除术在炎症性肠病（IBD）患者中的治疗效果。
纳入了比较机器人与腹腔镜结直肠切除术治疗 IBD 患者的研究。主要结局为总术后并发症发生率。次要结局包括手术时间、中转开腹手术、吻合口漏、腹腔脓肿形成、肠梗阻发生、手术部位感染、再次手术、再次入院率、住院时间和 30 天死亡率。使用随机效应模型计算合并的总效应大小，并使用纽卡斯尔-渥太华量表评估偏倚风险。
纳入了 11 项非随机研究[n=5566 例患者]，分为接受机器人[ n=365]和传统腹腔镜[ n=5201]手术的患者。与腹腔镜手术相比，机器人平台的总体术后并发症发生率显著降低[ p=0.03]。腹腔镜手术的手术时间明显缩短[ p=0.00001]。中转开腹手术率[ p=0.15]、吻合口漏[ p=0.84]、脓肿形成[ p=0.21]、麻痹性肠梗阻[ p=0.06]、手术部位感染[ p=0.78]、再次手术[ p=0.26]、再次入院率[ p=0.48]和 30 天死亡率[ p=1.00]在两组间无差异。与传统腹腔镜相比，机器人辅助全结肠切除术的住院时间更短[ p=0.03]。
在 IBD 的手术治疗中，传统腹腔镜技术和机器人辅助微创手术的治疗效果相当，证明了机器人平台的安全性和可行性。针对克罗恩病和溃疡性结肠炎分别使用机器人技术的更大规模研究可能会带来益处，重点关注与 IBD 相关的重要指标。
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