Robotic Versus Laparoscopic Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Systematic Review and Comparative Meta-Analysis.

Background

Ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure for patients with ulcerative colitis requiring colectomy. Although robotic-assisted surgery has gained increasing acceptance in colorectal surgery, its role in IPAA remains uncertain.

Methods

A systematic search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to May 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. Sensitivity analyses were conducted to analyze outcomes with moderate or substantial heterogeneity.

Results

Six comparative observational studies involving 946 patients were included; 460 underwent robotic-assisted IPAA, and 486 underwent laparoscopic IPAA. No significant differences were observed between approaches regarding anastomotic leak (OR: 0.69; 95% CI: 0.37 to 1.28; P = .234), bleeding (OR: 0.59; 95% CI: 0.21 to 1.64; P = .309), Clavien-Dindo grade III or higher complications (OR: 1.17; 95% CI: 0.57 to 2.41; P = .670), conversion to open surgery (OR: 0.46; 95% CI: 0.16 to 1.34; P = .156), postoperative ileus (OR: 1.11; 95% CI: 0.65 to 1.91; P = .705), overall morbidity (OR: 1.17; 95% CI: 0.84 to 1.63; P = .361), reoperation (OR: 1.06; 95% CI: 0.27 to 4.19; P = .933), or 30-day readmission (OR: 0.83; 95% CI: 0.59 to 1.17; P = .278). Likewise, no significant differences were identified in operative time (MD 26.3 minutes; 95% CI: -1.9 to 54.4; P = .07) or hospital stay (MD -0.5 days; 95% CI: -1.5 to 0.5; P = .34). Sensitivity analyses did not materially alter the direction or statistical significance of the pooled estimates despite moderate to high heterogeneity in selected outcomes.

Conclusion

Available observational evidence suggests that robotic-assisted IPAA yields short-term outcomes comparable to those of laparoscopic IPAA; however, the certainty of evidence is very low, and definitive conclusions are constrained by the observational nature of the available data.