Background: The laparoscopic surgery became the standard of care for the treatment of Crohn's disease only in the last ten years when many studies demonstrated that the minimally invasive colectomy and proctectomy have improved not only the short-term outcomes but also the fecundity rate of patients with a comparable long-term outcomes and safety over traditional open surgery. The reason of this slowly adoption and the hesitation of the surgeons to apply this new approach for the Crohn's disease was due to some specific difficulties like: the general condition of the patients caused by their chronic disease (anemia, malnutrition and immunosoppression)and the macroscopic aspect of the tissues (thickened and inflamed mesentery with a friable and bleeding tissues, the presence of a chronically dilated bowel loops). The introduction of the robotic platform not only is useful to reduce the post-operative adherence, almost 25–45% of patients undergo to a two or operation in their life but thanks to endowrist instrumetns and staplers may offer a significant benefit over laparoscopy in case of deep and narrow space like pelvis.
Methods: We analyzed our first 5 cases of robotic total proctocolectomy for Crohn's disease surgery from 1st October 2015 to 1st October 2016, evaluating benefits of the robotic platform and performing a comparison between the robotic (5 cases) and laparoscopic (8 cases) approach in a matched based group on demographic, comorbidities and performance status.
Results: All the patients treated underwent to total proctocolectomy with stapled anastomosis, the overall operative time in the robotic group was higher than laparoscopy (335 vs 234 min) as well as the estimated blood loss (350 vs 195 ml). We had one conversion in the first group and 3 in the laparoscopic one. The return of first bowel movement (2.42 vs 2.88 days) and the length of hospital stay (7.46 vs 9.23 days) showed a better result in the patients treated by robotic approach. The intra and post-operative complications rate was similar in both group (1 vs 2).
Conclusions: Even if the longer operative time and the higher estimated blood loss, the robotic approach is a safe and feasible technique and can offer benefits over the laparoscopic approach in case of low rectal dissection thanks to the stable retraction and a magnified view and it can lead to a lower conversion rates. Despite the small number of patients the robotic approach is comparable to open with regard to perioperative outcomes, complications rate and short terminal functional outcomes. We believe is recommended evaluate further the impact of robotic platform in the quality of life of these patients and the impact of the new model Da Vinci Xi system with its wider range of motion in case of multiquadrant surgery.