Early experience with urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable perioperative outcomes to laparoscopic surgery.

Abstract

It has been established that patients undergoing subtotal colectomy for UC benefit from a minimally invasive approach, despite the longer operating times associated with laparoscopic surgery when compared to open surgery (Andersson and Söderholm in Dig Dis 27(3):335-340, 2009; Telem et al. in Surg Endosc 24(7):1616-1620, 2010; Wu et al. in Int J Colorectal Dis 25(8):949-957, 2010). Our objective is to present our early experience with urgent robotic subtotal colectomy (RSTC) and compare them to a matched cohort of patients who underwent urgent laparoscopic subtotal colectomy (LSTC). A prospectively maintained institutional database was queried. Six RSTC patients and 13 LSTC patients were identified from 2015 to 2017. There was no difference in ASA score, body mass index, preoperative steroid use, c. difficile infection, or inflammatory markers between the groups. All patients in the robotic group and eight patients in the laparoscopic group received preoperative biologics. Neither group had intraoperative complications, open conversions, or 30-day mortality recorded. Robotic STC took 29min longer (323.0 vs. 294.0min, p = 0.3). There was no significant difference in blood loss between the two groups (80ml vs. 75ml p = 0.9). There were six postoperative complications (46%) in the laparoscopic group and 1 (20%) in the robotic group. Of these 23% (3/13) for LSTC and 0% (0/5) for RSTC were Grade III or higher. Two laparoscopic and 0 robotic patients required reoperation. The RSTC group had earlier stoma function (1.4 ± 0.8days vs. 2 ± 1.3days) and shorter LOS (3.4 ± 2 vs. 4.6 ± 3.2) than the LSTC group, but these did not reach statistical significance. In conclusion, urgent robotic subtotal colectomy for UC is safe and offers technical advantages.