Robot surgery for Inflammatory Bowel Disease

Treatment for IBD progresses every year, with the use of biologics reducing the rate of surgery. However, in IBD that does not respond to treatment with medication, surgery may be required, with a 10% chance of surgery in ulcerative colitis and 30% in Crohn’s disease over a ten-year period. Typically, minimally invasive techniques such as laparoscopic surgery (also known as keyhole surgery) are used, which reduces the pain during recovery, leads to shorter hospital stays and has a lower risk of complications compared to laparotomy (open surgery). Surgery in patients with IBD is in general challenging due to the changes in anatomy caused by inflammation. 

Robotic surgery or robot assisted surgery is a type of surgical technique which utilises a robot platform that enhances the precision of hand movements and visual perception of the surgeon undertaking the surgery. It was first used in 2004, with only a few cases, and has vastly increased to almost 20,000 in 2022. It is already commonly used for complex surgeries such as prostate surgery and removal of colon cancers in a minimally invasive manner. 

A 2024 study published in the Journal of Crohn’s and Colitis evaluated the use of robotic surgery for colon resection in patients with inflammatory bowel disease (IBD) compared to standard laparoscopic techniques. The systematic review analysed 11 studies consisting of over 5000 patients. It found that robotic surgery achieved similar outcomes compared to laparoscopic surgery. It had an overall lower complication rate and a shorter length of stay in hospital for certain types of surgery but surgeries on average took longer compared to laparoscopic surgery, with this being attributed to the lack of familiarity and a ‘learning curve’. More research will need to be undertaken in this area as the studies that were included did not investigate long term outcomes, mortality and recurrence of disease after resection.

Unfortunately, robotic surgery for IBD is still in its infancy so it is unlikely that if you have a surgery soon it will be undertaken using a robotic platform. Despite the number of operations performed a year using robotic surgery, only 17% of those are used in general surgery with the vast majority used in urology. There is also a difference in the number of platforms available for public patients and rural patients, with only 26 of the total 162 available in public hospitals and only 14 in rural and remote hospitals. This disparity has been identified by The Royal Australasian College of Surgeons and a working group formed to address these issues.