Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience

doi:10.21203/rs.3.rs-4618724/v1

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Research Article

Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience

https://doi.org/10.21203/rs.3.rs-4618724/v1

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Purpose

The aim of the study was to compare the perioperative outcomes of patients who underwent surgery performed through laparoscopy or using the Medtronic Hugo™ RAS

Methods

This is a retrospective study from a prospectively maintained database comparing laparoscopic vs. robotic assisted surgery for IBD from 01/11/2017 to 15/04/2024. All procedures were performed by a single surgeon robotic-naïve with a large experience in laparoscopic surgery for IBD. The robotic procedures were performed using the Medtronic Hugo™ RAS platform (Medtronic, Minneapolis, MN, USA). Outcome were 30-day postoperative complications, operative time, conversion rate, intraoperative complications, length of hospital stay, and readmission rate.

Results

Among 121 consecutive patients, 80 underwent laparoscopic (LG) and 41 robotic-assisted surgery (RG). Baseline, preoperative and disease-specific characteristics were comparable except for older age (50 [38–56] vs. 38 [28–54] years; p = 0.05) and higher albumin (42 [40–44] vs. 40 [38–42] g/L, p = 0.006) in the RG. Intracorporeal anastomosis was more frequent in the RG (80% vs. 6%; p < 0.001) with longer operative time (240 vs. 205min; p = 0.006), while the conversion rate was not different (5% vs. 10%, p = 0.49). Postoperative complications were similar, including the rate of intra-abdominal septic complications (5% vs. 5%, p = 1), postoperative ileus (5% vs. 7.5%, p = 0.71), bleeding (2% vs. 5%, p = 0.66) and Clavien-Dindo > 2 complications (7% vs. 6%; p = 1).

Conclusion

IBD surgery performed using the Medtronic Hugo™ RAS is safe and feasible, with similar postoperative outcomes when compared to the laparoscopic approach.

*Matteo Rottoli & Stefano Cardelli are equal first authors.

inflammatory bowel disease

robotic surgery

robotic platform

Hugo RAS

outcome

The management of Inflammatory Bowel Disease (IBD) frequently requires surgery. National and international guidelines advocate minimally invasive surgery as the preferred approach both for Crohn's disease (CD) ^1,2 and ulcerative colitis (UC) ^3,4, whenever feasible.

The use of robotic platforms in colorectal surgery has grown exponentially over the last years ^5,6. A few reports from referral centres showed that robotic surgery is also feasible in the treatment of IBD and is associated with comparable or even improved postoperative outcomes as compared to the laparoscopic approach ^7–11.

Among the different existing platforms on the market, the Medtronic Hugo™ robotic-assisted surgery (RAS) system has been successfully introduced in urology, gynecology, and general surgery over the last two years. This system has technical characteristics that could potentially improve the implementation of the platform in colorectal surgery.

However, there is still a lack in the literature regarding the feasibility and outcomes of the use of this novel platform in the surgical treatment of IBD patients, which often require complex colorectal procedures.

Therefore, the aim of the study was to compare the perioperative outcomes of patients who underwent surgery performed through laparoscopy or using the Medtronic Hugo™ RAS.

This was a retrospective study including consecutive adult patients who underwent minimally invasive (laparoscopic or robotic) surgery for IBD from 01/11/2017 to 15/04/2024 at our institution. The data was retrieved from a prospectively maintained database hosted on the Alma Mater Studiorum University of Bologna REDCap (Research Electronic Data Capture) platform ¹². The robotic series started in July 2023. There was no preoperative selection of patients who underwent robotic surgery, as factors such as the operating room availability and the waiting list primarily determined the approach. Patients younger than eighteen years old, without a histologic diagnosis of IBD, and who underwent oncologic or emergent surgery were excluded from the analysis. All procedures were performed by a single surgeon with a large experience in laparoscopic surgery for IBD (> 500 laparoscopic procedures), and who was robotic-naïve. The surgeon underwent the required certification for using the robotic platform and previously performed 20 other robotic procedures (colorectal non-IBD, cholecystectomies). Robotic procedures were performed using the Medtronic Hugo™ RAS platform (Medtronic, Minneapolis, MN, USA).

The primary outcome was the comparison of the 30-day overall postoperative complication rate. The secondary outcomes included the comparison of the operative time, conversion rate, intraoperative complications, length of hospital stay, and readmission rate.

The analyzed variables included demographics, age, sex, body mass index (BMI), smoking, American Society of Anesthesiologist (ASA) score, preoperative medical therapy (including steroid, immunomodulator or biologics), serum albumin, hemoglobin, C-reactive protein, preoperative antibiotics, preoperative drainage of intra-abdominal collection, preoperative nutritional parenteral nutrition, previous abdominal surgery, indication for surgery, conversion (considered as a laparotomy created for any purpose other than specimen extraction) ¹³, associated surgical procedures, intra-corporeal anastomosis (ICA) construction, intraoperative complications, operative time, postoperative length of stay and readmission. CD-specific characteristics, such as CD duration, CD age, CD behavior according to the Montreal classification, anoperineal disease, and complex CD (defined as the presence of an intraoperative intra-abdominal abscess, fistula, or inflammatory mass) were also collected. No modification has been made in the preoperative optimization between the two groups according to bowel preparation, medical therapy suspension, preoperative sepsis treatment^14–18. The postoperative complications were categorized according to the Clavien-Dindo classification ¹⁹. The diagnosis of anastomotic leak (AL) was based on the validated definition proposed by the International Study Group of Rectal Cancer (ISREC), which considered AL also the pelvic abscesses located in the proximity of the anastomosis, whether or not the origin is detectable ²⁰.

The study was conducted according to the Declaration of Helsinki guidelines and the Ethical Committee approval was obtained. The manuscript was structured according to the STROBE cohort reporting guidelines ²¹. Statistical analysis was conducted using R4.3.2 ²². The continuous variables were summarized as median [IQR], and categorical variables were reported as frequency (percentage). Continuous variables were compared between the robotic group (RG) and laparoscopic group (LG) using the Wilcoxon rank sum test, and categorical variables were compared using the Chi-squared or Fisher’s exact test, as appropriate. All tests were two-sided; a significant difference was considered with an alpha level < 0.05.

Between November 2017 and April 2024, 121 consecutive patients were included in the study. Of these, 80 were performed laparoscopically, and 41 underwent robotic-assisted surgery.

Table 1 summarizes the demographic data. Baseline characteristics were comparable between the LG and RG, except for age, since patients in the RG were older (mean age: 50 vs. 38 years; p = 0.05).

The preoperative disease-specific characteristics were comparable between the two groups, as reported in Table 2, including the preoperative exposure to biologic therapies (46% vs. 50%; p = 1).

Ileocecal resection with a stapled side-to-side ileo-colic anastomosis was the most frequent surgical intervention (18/21 in the RG and 31/42 in the LG). Notably, ICA construction was more frequently performed with the robotic-assisted platform (80% vs. 6%; p < 0.001).

The intraoperative and postoperative surgical characteristicsare summarized in Table 3. CD and UC diagnosis and type of procedures were similar between the two groups. Patients in RG had a higher median [IQR] albumin concentration as compared to the LG (42 g/L [40–44] vs. 40 g/L [38–42], p = 0.006).

The operative time was significantly longer in the RG group than in the LG group (240 vs. 205 minutes; p = 0.006), while the conversion rate was comparable (5% vs. 10%, p = 0.49).

Postoperative medical and surgical complications were similar between the two groups, including the rate of intra-abdominal septic complications (5% vs. 5%, p = 1), postoperative ileus (5% vs. 7.5%, p = 0.71) and bleeding (2% vs. 5%, p = 0.66). The rate of Clavien-Dindo > 2 complications was also similar in the two groups (7% vs. 6%; p = 1).

Taking into account the recent introduction of this platform in the market, this is the first comparative study to report outcomes after surgery for IBD using the Medtronic Hugo™ RAS. The comparison of the two groups showed similar postoperative outcomes and comparable preoperative and intraoperative characteristics, confirming that no preoperative selection based on the clinical presentation, the behavior of disease or the anticipated difficulty of surgery was carried out. The robotic procedures included a range of common operations performed in patients with IBD, including ileocecal resection, right extended colectomy, total colectomy, proctectomy with ileal-pouch anal anastomosis (IPAA), and abdominal perineal resection (APR). Such variability highlights the platform's flexibility in terms of its application in colorectal surgery, regardless of the case's complexity.

The comparable rates of complication and conversion between laparoscopic and robotic surgery support the smoothness of the transition between the two approaches since the present surgeries were carried out by a robotic-naïve surgeon. Although defining the learning curve will require a larger, possibly multicentric series ²³, these early findings suggest that laparoscopic expertise might translate to the robotic approach yielding non-inferior outcomes using this platform.

Not surprisingly, a higher rate of ICAs was found in the robotic group, and similar findings were shown in previous studies ^9,24,25. The advantages of the robotic platform in terms of 3D visualization, articulating instruments, and improved precision likely led to greater confidence when performing the mesenteric division (which might prove difficult in CD as a consequence of the increased thickness and the tendency to bleed) and the subsequent anastomosis, which often sits in uncomfortable positions as the ascending colon is usually preserved. ICA is associated with advantages including using off-midline extraction, better pain control, an earlier return to bowel function, and minimizing potential tension placed on thickened and fore shortened mesentery, leading to improved recovery and long-term outcomes ^7,8,26.

The benefits of robotic-assisted proctectomy and IPAA reported in previous studies ^27–31, were also confirmed in this early experience with the Medtronic Hugo™ RAS platform, particularly regarding the enhanced articulation in the low pelvis and the possibility of mobilizing the rectum distally to the level of the anorectal junction more easily in order to achieve a short rectal cuff.

The limitations of the present study included the retrospective nature, the single centre and single surgeon design, and the small sample size. However, this early experience supports the extensive use of Medtronic Hugo™ RAS in colorectal and in IBD surgery. The technical characteristics of the platform accommodate some of the needs of colorectal surgery, which are not found in other specialties, such as urology or gynecology. Being a modular system, in fact, it might overcome the intrinsic difficulties associated with the large surgical field of colorectal surgery just by moving one or two arms in different docking set-ups while moving from one surgical field to the other (i.e., from the splenic flexure to the pelvis).

In conclusion, IBD surgery performed using the Medtronic Hugo™ RAS is safe and feasible, with similar postoperative outcomes when compared to the laparoscopic approach. Randomized multicentre studies will be needed to assess the clinical advantages in larger series.

Table 1

Demographics
	Robotic (tot = 41)	Laparoscopic (tot = 80)	p-value
Age, Median [Q1 - Q3]	50 [37.5–55.5]	38 [28–54.4]	0.05
Male gender	22 (56%)	48 (60%)	0.63
BMI, Median [Q1 - Q3]	23 [22–24]	20 [18.5–21.5]	0.14
Smoking History			0.16
Never smoked	13 (32%)	42 (52.5%)
Suspended	9 (22%)	18 (22.5%)
Smoking now	13 (32%)	17 (21%)
ASA, Median [Q1 - Q3]	2 [2–2]	2 [2–2]	0.66
Previous Abdominal Surgeries	12 (29%)	13 (16.5%)	0.15
Preoperative Therapy
Antibiotics	3 (7%)	9 (11.5%)	0.74
Steroids	6 (15%)	19 (24%)	0.33
Immunomodulators	1 (2%)	3 (4%)	1
Previous Biologic Therapy	26 (63%)	38 (47.5%)	0.14
Current Biologic Therapy	0	2 (2.5%)	0.51
Multiple Biologic Therapies	19 (46%)	23 (29%)	0.44
Years of disease, Median [Q1 - Q3]	7 [3–14]	10 [7–13]	0.33

BMI: body mass index, ASA: American Society of Anaesthesiologists.

Table 2. Crohn disease-specific characteristics
	Robotic (tot = 21)	Laparoscopic (tot = 42)	p-value
Penetrating disease behaviour	6 (29%)	18 (43%)	0.35
Recurrent CD	1 (5%)	0	0.32
Complex CD	4 (19%)	17 (40%)	0.12
Preoperative parenteral nutrition	0	4 (9%)	0.28
Preoperative biologic therapy	11 (46%)	21 (50%)	1
current	0	2 (5%)
multiple previous lines	7 (34%)	12 (29%)
Perianal CD requiring surgery	3 (14%)	6 (14%)	1
Ileal resections	2 (9.5%)	2 (5%)	1
Side-to-side anastomosis	2 (100%)	2 (100%)
Stapled anastomosis	2 (100%)	2 (100%)
Ileocecal resection	18 (86%)	31 (74%)	1
Side-to-side anastomosis	18 (100%)	31 (100%)
Stapled anastomosis	18 (100%)	31 (100%)
ICA	16 (80%)	2 (6%)	< 0.001
CD: Crohn’s disease; ICA: intracorporeal anastomosis

Table 3

Perioperative and postoperative surgical characteristics
	Robotic (tot = 41)	Laparoscopic (tot = 80)	p - value
Albumin at surgery (g/L), Median [IQR]	42 [40–44]	40 [38–42]	0.006
Hemoglobin at surgery (g/L), Median [IQR]	12.5 [11–13]	12 [11–13.5]	0.15
Open conversion	2 (5%)	8 (10%)	0.49
CD diagnosis	21 (51%)	42 (52.5%)	1
UC diagnosis	20 (49%)	38 (47.3%)	1
Surgical intervention type			0.59
Ileal or ileocecal resection alone	20 (49%)	32 (40%)
Ileocecal resection and concomitant colonic resection	0	3 (4%)
Right extended colonic resection	1 (2%)	7 (8.5%)
Proctectomy and IPAA	16 (39%)	28 (35%)
Abdominal perineal resection	2 (5%)	3 (4%)
Total colectomy	2 (5%)	7 (8.5%)
Duration of surgery (min), Median [IQR]	240 [185 − 290]	205 [150–240]	0.002
Length of Hospital Stay (days), Median [IQR]	6 [6–7]	6 [6–7]	0.78
Postoperative Medical complication	4 (10%)	7 (8.5%)	0.74
Postoperative Surgical Complication	8 (20%)	14 (17.5%)	0.98
Intra-abdominal septic complications	2 (5%)	4 (5%)	1
Paralytic ileus	2 (5%)	6 (7.5%)	0.71
Bowel occlusion	1 (2%)	2 (2.5%)	1
Bleeding complication	1 (2%)	4 (5%)	0.66
Clavien-Dindo classification > 2	3 (7%)	5 (6%)	1
30-day mortality	0	0	-

CD: Crohn’s disease; IPAA: ileo-pouch anal anastomosis; APR: abdominoperineal resection; IQR: interquartile range; UC: Ulcerative Colitis.

Author contribution

Rottoli Matteo: Conceptualization, Writing – review & editing, Resources, Funding acquisition, Supervision;

Cardelli Stefano: Data curation, Formal Analysis, Writing – original draft;

Calini Giacomo: Conceptualization, Methodology, Investigation, Validation, Writing – original draft, Resources;

Ioana Diana Alexa: Data curation, Writing – review & editing;

Violante Tommaso: Writing – review & editing;

Poggioli Gilberto: Conceptualization, Resources, Supervision, Writing – review & editing;

Conflict of interest

Matteo Rottoli declare the following conflict of interest: Medtronic advisory board. The other authors declare no conflict of interest.

Funding

The research leading to these results has received funding from the European Union - NextGenerationEU through the Italian Ministry of University and Research under PNRR - M4C2-I1.3 Project PE_00000019 "HEAL ITALIA" to Matteo Rottoli CUP J33C22002920006.

The views and opinions expressed are those of the authors only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.

Adamina M, Bonovas S, Raine T, Spinelli A, Warusavitarne J, Armuzzi A, Bachmann O, Bager P, Biancone L, Bokemeyer B, Bossuyt P, Burisch J, Collins P, Doherty G, El-Hussuna A, Ellul P, Fiorino G, Frei-Lanter C, Furfaro F, Gingert C, Gionchetti P, Gisbert JP, Gomollon F, González Lorenzo M, Gordon H, Hlavaty T, Juillerat P, Katsanos K, Kopylov U, Krustins E, Kucharzik T, Lytras T, Maaser C, Magro F, Marshall JK, Myrelid P, Pellino G, Rosa I, Sabino J, Savarino E, Stassen L, Torres J, Uzzan M, Vavricka S, Verstockt B, Zmora O (2020) ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment. J CrohnsColitis. ;14(2):155–168. 10.1093/ecco-jcc/jjz187. PMID: 31742338
Pellino G, Keller DS, Sampietro GM, Angriman I, Carvello M, Celentano V, Colombo F, Di Candido F, Laureti S, Luglio G, Poggioli G, Rottoli M, Scaringi S, Sciaudone G, Sica G, Sofo L, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F, Italian Society of Colorectal Surgery SICCR (2020) Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn's disease. Tech Coloproctol 24(5):421–448. 10.1007/s10151-020-02183-zEpub 2020 Mar 14. Erratum in: Tech Coloproctol. 2020;: PMID: 32172396
Spinelli A, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Doherty G, Raine T, Panis Y (2022) ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J CrohnsColitis. ;16(2):179–189. 10.1093/ecco-jcc/jjab177. PMID: 34635910
Pellino G, Keller DS, Sampietro GM, Carvello M, Celentano V, Coco C, Colombo F, Geccherle A, Luglio G, Rottoli M, Scarpa M, Sciaudone G, Sica G, Sofo L, Zinicola R, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F, Italian Society of Colorectal Surgery SICCR (2020) Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis. Tech Coloproctol 24(5):397–419 Epub 2020 Mar 2. Erratum in: Tech Coloproctol. 2020;: PMID: 32124113
Sheetz KH, Claflin J, Dimick JB (2020) Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw Open 3(1):e1918911. 10.1001/jamanetworkopen.2019.18911PMID: 31922557; PMCID: PMC6991252
Ferrari D, Violante T, Novelli M, Starlinger PP, Smoot RL, Reisenauer JS, Larson DW (2024) The death of laparoscopy. Surg Endosc 38(5):2677–2688. 10.1007/s00464-024-10774-2Epub 2024 Mar 22. PMID: 38519609
Zaman S, Mohamedahmed AYY, Abdelrahman W, Abdalla HE, Wuheb AA, Issa MT, Faiz N, Yassin NA Minimally invasive surgery for Inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques. J Crohns Colitis. 2024 Mar 11:jjae037. 10.1093/ecco-jcc/jjae037. Epub ahead of print. PMID: 38466108
Renshaw S, Silva IL, Hotouras A, Wexner SD, Murphy J, Bhan C (2018) Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review. Tech Coloproctol 22(3):161–177. 10.1007/s10151-018-1766-5Epub 2018 Mar 15. PMID: 29546470; PMCID: PMC5862938
Calini G, Abdalla S, Abd El Aziz MA, Merchea A, Larson DW, Behm KT (2023) Ileocolic resection for Crohn's disease: robotic intracorporeal compared to laparoscopic extracorporeal anastomosis. J Robot Surg 17(5):2157–2166. 10.1007/s11701-023-01635-6Epub 2023 Jun 1. PMID: 37264221
Abdalla S, Abd El Aziz MA, Calini G, Saeed H, Merchea A, Shawki S, Behm KT, Larson DW (2022) Perioperative outcomes of minimally invasive ileocolic resection for complicated Crohn disease: Results from a referral center retrospective cohort. Surgery 172(2):522–529 Epub 2022 Mar 23. PMID: 35337682
Abd El Aziz MA, Abdalla S, Calini G, Saeed H, D'Angelo AL, Behm KT, Shawki S, Mathis KL, Larson DW (2023) Robotic Redo Ileocolonic Resection for Crohn's Disease: A Preliminary Report From a Tertiary Care Center. Dis Colon Rectum 66(8):1095–1101 Epub 2022 Nov 21. PMID: 36538722
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 42(2):377–381. 10.1016/j.jbi.2008.08.010Epub 2008 Sep 30. PMID: 18929686; PMCID: PMC2700030
Shawki S, Bashankaev B, Denoya P, Seo C, Weiss EG, Wexner SD (2009) What is the definition of conversion in laparoscopic colorectal surgery? Surg Endosc 23(10):2321–2326. 10.1007/s00464-009-0329-2Epub 2009 Mar 6. PMID: 19266238
Abd El Aziz MA, Grass F, Calini G et al (2022) Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects. Dis Colon Rectum 65(9):e897–e906. 10.1097/DCR.0000000000002096
Dajti G, Cardelli S, Calini G et al (2024) Oral Budesonide and low serum albumin levels at surgery are associated with a higher risk of postoperative intra-abdominal septic complications after primary ileocaecal resection for Crohn's disease: A retrospective analysis of 853 consecutive patients. Dig Liver Dis Published online April 13. 10.1016/j.dld.2024.03.014
Abd El Aziz MA, Abdalla S, Calini G et al (2022) Postoperative Safety Profile of Minimally Invasive Ileocolonic Resections for Crohn's Disease in the Era of Biologic Therapy. J Crohns Colitis 16(7):1079–1088. 10.1093/ecco-jcc/jjac012
Calini G, Canavese A, Dajti G et al (2024) P414 Timing of biologics discontinuation is not associated with postoperative complications (POCs), infective complications, bleeding, or intra-abdominal septic complications (IASCs) after primary ileocecal resection for Crohn’s Disease: a retrospective analysis of 237 patients in a tertiary centre, Journal of Crohn's and Colitis, Volume 18, Issue Supplement_1, January Pages i854–i856, 10.1093/ecco-jcc/jjad212.0544
Celentano V, Giglio MC, Pellino G et al (2022) High complication rate in Crohn's disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study. Int J Colorectal Dis 37(6):1421–1428. 10.1007/s00384-022-04183-x
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. ;250(2):187 – 96. 10.1097/SLA.0b013e3181b13ca2. PMID: 19638912
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351. 10.1016/j.surg.2009.10.012
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J ClinEpidemiol. ;61(4):344-9. doi: 10.1016/j.jclinepi.2007.11.008. PMID: 18313558
R Core Team (2021) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/
Flynn J, Larach JT, Kong JCH, Waters PS, Warrier SK, Heriot A (2021) The learning curve in robotic colorectal surgery compared with laparoscopic colorectal surgery: a systematic review. Colorectal Dis 23(11):2806–2820. 10.1111/codi.15843Epub 2021 Aug 15. PMID: 34318575
Aydinli HH, Anderson M, Hambrecht A, Bernstein MA, Grucela AL (2021) Robotic ileocolic resection with intracorporeal anastomosis for Crohn's disease. J Robot Surg 15(3):465–472. 10.1007/s11701-020-01125-zEpub 2020 Jul 28. PMID: 32725327
Calini G, Abdalla S, Abd El Aziz MA, Saeed HA, D'Angelo AD, Behm KT, Shawki S, Mathis KL, Larson DW (2022) Intracorporeal versus extracorporeal anastomosis for robotic ileocolic resection in Crohn's disease. J Robot Surg 16(3):601–609. 10.1007/s11701-021-01283-8Epub 2021 Jul 27. PMID: 34313950
Calini G, Abdalla S, Aziz MAAE et al (2023) Incisional hernia rates between intracorporeal and extracorporeal anastomosis in minimally invasive ileocolic resection for Crohn's disease. Langenbecks Arch Surg. ;408(1):251. Published 2023 Jun 29. 10.1007/s00423-023-02976-4
Abd El Aziz MA, Calini G, Grass F et al (2021) Minimally invasive ileal pouch-anal anastomosis for patients with obesity: a propensity score-matched analysis. Langenbecks Arch Surg 406(7):2419–2424. 10.1007/s00423-021-02197-7
Flynn J, Larach JT, Kong JCH, Warrier SK, Heriot A (2021) Robotic versus laparoscopic ileal pouch-anal anastomosis (IPAA): a systematic review and meta-analysis. Int J Colorectal Dis 36(7):1345–1356. 10.1007/s00384-021-03868-zEpub 2021 Feb 20. PMID: 33611619
Burghgraef TA, Sikkenk DJ, Crolla RMPH et al (2023) Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency. Int J Colorectal Dis. ;38(1):9. Published 2023 Jan 11. 10.1007/s00384-022-04303-7
El-Ahmar M, Peters F, Green M et al (2024) Robotic colorectal resection in combination with a multimodal enhanced recovery program - results of the first 100 cases [published correction appears in Int J Colorectal Dis. ;39(1):42. doi: 10.1007/s00384-024-04611-0]. Int J Colorectal Dis. 2023;38(1):95. Published 2023 Apr 13. 10.1007/s00384-023-04380-2
Wu H, Guo R, Li H (2023) Short-term and long-term efficacy in robot-assisted treatment for mid and low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. ;39(1):7. Published 2023 Dec 21. 10.1007/s00384-023-04579-3

Competing interest reported. Matteo Rottoli declares the following conflict of interest: Medtronic advisory board. The other authors declare no conflict of interest.

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Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience

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