Robotic Versus Laparoscopic Surgery for Crohn's Disease: A Systematic Review and Meta-Analysis with Trial Sequential Analysis.

BACKGROUND

Laparoscopic surgery (Lap) is widely recognized as the standard minimally invasive method for colorectal surgeries. Although robotic surgery (Rob) has seen increased adoption, its application in inflammatory bowel disease remains uncertain.

METHODS

A systematic search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to February 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via the inconsistency (I2) statistic. Trial sequential analysis (TSA) was applied to assess the robustness of the cumulative evidence.

RESULTS

Four observational studies, including 3776 patients, were analyzed; 246 underwent Rob and 3530 underwent Lap. Compared with Lap, Rob was associated with a significantly lower rate of overall postoperative complications (OR: 0.56; 95% CI: 0.31 to 0.99; P = .047). No significant differences were observed between approaches in postoperative ileus (OR: 1.16; 95% CI: 0.67 to 2.01; P = .595), anastomotic leak (OR: 0.92; 95% CI: 0.38 to 2.22; P = .852), surgical site infection (OR: 0.70; 95% CI: 0.36 to 1.36; P = .297), reoperation (OR: 1.00; 95% CI: 0.42 to 2.35; P = .997), or stoma formation (OR: 0.47; 95% CI: 0.18 to 1.25; P = .130). The length of hospital stay was similar between groups (MD: = -0.20 days; 95% CI: = -0.80 to 0.31; P = .37). Operative time was significantly longer in Rob (MD: + 51.8 minutes; 95% CI: 32.0 to 71.6; P < .001). TSA indicated that most outcomes remained underpowered, suggesting a persistent risk of random error.

CONCLUSION

Rob for Crohn's disease is a safe and feasible minimally invasive approach, with lower overall postoperative complications than Lap. However, Rob was associated with longer operative times, while most perioperative outcomes remain comparable. Further well-designed prospective studies are required to confirm these findings.