Standardisation in robotic surgery for inflammatory bowel disease: a systematic review

TL;DR

This review finds that robotic surgery for inflammatory bowel disease lacks standardization in techniques and outcome reporting, limiting the reliability of current evidence.

Contribution

The study systematically evaluates the lack of standardization in robotic surgery for IBD, highlighting gaps in reproducibility and outcome definitions.

Findings

Most studies on robotic IBD surgery are retrospective and single-arm, with inconsistent technical reporting.

There is significant variability in port placement, docking, and intraoperative techniques across studies.

Outcome definitions and Enhanced Recovery After Surgery protocol use are poorly reported in the literature.

Abstract

Robotic-assisted surgery offers technical advantages over laparoscopy, including improved dexterity and visualisation. However, its role in inflammatory bowel disease (IBD) remains poorly defined, with existing studies limited by variability and lack of standardisation. This systematic review aimed to evaluate the reproducibility, operative detail, outcome reporting, and procedural consistency in the current literature on robotic-assisted surgery for IBD. A systematic review was conducted following PRISMA 2020 guidelines and registered on PROSPERO (CRD42024514488). Comprehensive searches of five databases and grey literature from January 2015 to April 2024 were performed. Studies involving robotic surgery in adult IBD patients were included. Methodological quality was assessed using the Newcastle–Ottawa Scale. Sixteen studies involving 614 patients met inclusion criteria. Most were retrospective (81.3%) and single-arm (62.5%), with robotic ileocolic resection being the most common procedure (50%). Significant heterogeneity existed in port placement, docking, and intraoperative techniques. Technical reporting, particularly on robotic setup, was inconsistent. Definitions of postoperative outcomes, including complications and conversion rates, varied across studies. Enhanced Recovery After Surgery protocols were used in 18.8% of studies, with minimal reporting of patient-reported outcomes. While risk of bias was generally low, limited follow-up and absence of comparator arms reduced the strength of conclusions. Current evidence on robotic surgery in IBD is methodologically variable and poorly standardised, particularly regarding technical setup and outcome definitions. Future research should focus on prospective, multicentre studies with detailed intraoperative data, standardised outcomes, and long-term follow-up.

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