Presentation (CTI)

OBJECTIVES: This review and meta-analysis compare perioperative outcomes for robotic-assisted surgery(RAS) using da Vinci surgical systems, laparoscopic surgery(Lap), and open surgery for colectomy or proctectomy in benign colon conditions.
METHODS: A PRISMA-guided literature review and meta-analysis compared RAS with Lap and open approaches in patients with benign colon indications (Diverticular disease(DD)/Ulcerative colitis(UC)/Crohn’s disease(CD)). The 12-year search across PubMed, Embase, and Scopus included studies in English and excluded those involving pediatric cases, malignancies, irrelevant outcomes, or redundant data. Key outcomes assessed were operative time, conversions, transfusions, blood loss, hospital stay, recovery milestones, complications, 30-day reoperations and mortality.
RESULTS: Search identified 24 publications, majority reported on DD(15/24). When compared to Lap, RAS had a longer operative time by 51 minutes(MD:50.80[36.75;64.84],p<0.01), 47% lower likelihood of conversion to open surgery(OR:0.53[0.39;0.70],p<0.01), shorter hospital stay by 0.5 days(MD:-0.54[-0.79;-0.29],p<0.01), quicker time to first bowel movement by 0.7 days(MD:-0.75[-1.06;-0.45],p<0.01), shorter time to flatus by 0.3 days(MD:-0.32[-0.49;-0.15],p<0.01) and was 14% less likely to experience 30-day postoperative complications(OR:0.86[0.77;0.96],p<0.01). No significant differences were observed for blood loss, transfusions, intraoperative complications, anastomotic-leak, ileus, surgical site infections, urinary tract infections, stoma, pain medications and 30-day major complications, reoperations and mortality rates.When compared to open, RAS had longer operative time by 87 minutes(MD: 86.68[48.93;124.42],p<0.01), 63% lower likelihood of blood transfusion(OR:0.37[0.24;0.57],p<0.01), 61% lower anastomotic-leak(OR:0.39[0.19;0.80],p=0.01), 33% lower ileus rates(OR:0.67[0.54;0.82],p<0.01), shorter hospital stay by 2.9 days(MD:-2.85[-4.84;-0.87],p<0.01) and 47% less likely to experience 30-day postoperative complications(OR:0.53[0.45;0.63],p<0.01). There were insufficient studies to compare RAS with open surgery on blood loss, time to bowel/flatus, major complications, stoma need, and pain medications. No differences were found in intraoperative complications, infections, 30-day reoperations and mortality.
CONCLUSIONS: Our review and analysis suggest that da Vinci surgical system is a feasible and safe option for benign colon surgery. Additional research is needed on surgery for UC and CD.