Short-term surgical outcomes of robotic-assisted versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis.

BACKGROUND

Laparoscopic and robotic-assisted approaches are increasingly used for ileal pouch-anal anastomosis (IPAA) after restorative proctocolectomy, yet direct comparisons of short-term outcomes are limited. This systematic review compared the collective short-term outcomes of laparoscopic and robotic-assisted IPAA.

METHODS

A PRISMA-compliant systematic review of PubMed, Scopus, and Cochrane Library was performed (January 2000-June 2025) to identify studies comparing robotic-assisted and laparoscopic IPAA. The primary outcome was 30-day complications and conversion to open surgery. Pairwise meta-analyses and random-effects meta-regression were conducted. The risk of bias was assessed using ROBINS-1 tool; evidence certainty was examined using GRADE.

RESULTS

8 cohort studies, comprising 1861 patients, were included. 1241 patients (66.7%) underwent laparoscopic IPAA, 620 (33.3%) underwent robotic-assisted IPAA. There were no significant differences in the odds of total (OR 0.97, 95%CI 0.66, 1.41, p = 0.855) or major complications (OR 1.11, 95%CI 0.81, 1.53, p = 0.511). Odds of ileus, small bowel obstruction, and anastomotic leak were comparable. Robotic-assisted IPAA was associated with significantly fewer conversions to open surgery (OR 0.25, 95%CI 0.08, 0.77, p = 0.015) but longer operative times (WMD 24.97, 95%CI 2.09, 47.85, p = 0.032). Blood loss and intraoperative complications did not significantly differ. Meta-regression showed the conversion benefit of robotic IPAA was more pronounced in male patients and those with higher ASA, ulcerative colitis, and 3-stage IPAA.

CONCLUSIONS

Robotic-assisted and laparoscopic IPAA have comparable short-term complication rates, with robotic-assisted surgery offering significantly lower risk of conversion but longer operative times. These findings confirm robotic-assisted IPAA is an acceptable alternative to laparoscopic IPAA; however, interpretation should be cautious given the observational design of the studies and overall low certainty of evidence. Surgeon expertise in technique and resource availability will influence operative approach.