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

Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience Matteo Rottoli*, Stefano Cardelli*, Giacomo Calini, Ioana Diana Alexa, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4618724/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Oct, 2024 Read the published version in International Journal of Colorectal Disease → Version 1 posted 9 You are reading this latest preprint version Abstract 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 Introduction 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. Materials and Methods 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. Results 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). Discussion 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. Tables 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. Declarations 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. 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Cite Share Download PDF Status: Published Journal Publication published 10 Oct, 2024 Read the published version in International Journal of Colorectal Disease → Version 1 posted Editorial decision: Revision requested 11 Jul, 2024 Reviews received at journal 11 Jul, 2024 Reviewers agreed at journal 28 Jun, 2024 Reviews received at journal 27 Jun, 2024 Reviewers agreed at journal 27 Jun, 2024 Reviewers invited by journal 26 Jun, 2024 Editor assigned by journal 24 Jun, 2024 Submission checks completed at journal 24 Jun, 2024 First submitted to journal 21 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4618724","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320656385,"identity":"8dafd3f6-4bf4-4e4d-a848-859034ce37c6","order_by":0,"name":"Matteo Rottoli*","email":"","orcid":"","institution":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Rottoli*","suffix":""},{"id":320656386,"identity":"6669ea60-ac7d-472b-a5ab-cd65435fb850","order_by":1,"name":"Stefano Cardelli*","email":"","orcid":"","institution":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Stefano","middleName":"","lastName":"Cardelli*","suffix":""},{"id":320656387,"identity":"d7d1467d-61ae-426f-979a-f33bec6fa773","order_by":2,"name":"Giacomo Calini","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACZgSr4QCDgY0cAwNjG5AnQYwWRpCWNGOYFjx6kLQAicOJQJKNAZ818u7MDz98zLFh4G8/2Hi4oIA5fcPt5rYHHxgs6nBpMTzMZiw5c1sag8SZxIbDMwzYcjfcOdhuOAOPwwybGcyYebcdZjBgAGrhMeDJ3XAjsU2aB68W9m8QLfwPQVok0g0IaZFn5oHaIgG2xSCBoBYDZp5ikF94JG6AbUkwnHkjEegXAwnJBly29B/f+OHjNhs5/v7kw595/vyX57uR/uzBh4o6fpy2HIDQPOjiuDQAbcFl/SgYBaNgFIwCOAAAd3ZRVkMj+PIAAAAASUVORK5CYII=","orcid":"","institution":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Giacomo","middleName":"","lastName":"Calini","suffix":""},{"id":320656390,"identity":"d0bb9bf2-266f-4bd8-bcd9-f61a8e5a6ed1","order_by":3,"name":"Ioana Diana Alexa","email":"","orcid":"","institution":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ioana","middleName":"Diana","lastName":"Alexa","suffix":""},{"id":320656388,"identity":"2584795d-3271-40ed-9602-cdf820509326","order_by":4,"name":"Tommaso Violante","email":"","orcid":"","institution":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tommaso","middleName":"","lastName":"Violante","suffix":""},{"id":320656389,"identity":"18b95809-61fc-4c41-98da-80976a93f085","order_by":5,"name":"Gilberto Poggioli","email":"","orcid":"","institution":"Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gilberto","middleName":"","lastName":"Poggioli","suffix":""}],"badges":[],"createdAt":"2024-06-21 17:31:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4618724/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4618724/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00384-024-04736-2","type":"published","date":"2024-10-10T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66597410,"identity":"f6c0322a-e707-43a5-b4ac-ff0508fd18d8","added_by":"auto","created_at":"2024-10-14 16:10:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":476033,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4618724/v1/c891237d-55d3-446a-9e66-7e37743bc4f5.pdf"}],"financialInterests":"Competing interest reported. Matteo Rottoli declares the following conflict of interest: Medtronic advisory board.\nThe other authors declare no conflict of interest.","formattedTitle":"Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe 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) \u003csup\u003e1,2\u003c/sup\u003e and ulcerative colitis (UC) \u003csup\u003e3,4\u003c/sup\u003e, whenever feasible.\u003c/p\u003e \u003cp\u003eThe use of robotic platforms in colorectal surgery has grown exponentially over the last years \u003csup\u003e5,6\u003c/sup\u003e. 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 \u003csup\u003e7\u0026ndash;11\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAmong the different existing platforms on the market, the Medtronic Hugo\u0026trade; 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.\u003c/p\u003e \u003cp\u003eHowever, 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.\u003c/p\u003e \u003cp\u003eTherefore, the aim of the study was to compare the perioperative outcomes of patients who underwent surgery performed through laparoscopy or using the Medtronic Hugo\u0026trade; RAS.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis 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 \u003csup\u003e12\u003c/sup\u003e. 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 (\u0026gt;\u0026thinsp;500 laparoscopic procedures), and who was robotic-na\u0026iuml;ve. 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\u0026trade; RAS platform (Medtronic, Minneapolis, MN, USA).\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eThe 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) \u003csup\u003e13\u003c/sup\u003e, 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\u003csup\u003e14\u0026ndash;18\u003c/sup\u003e. The postoperative complications were categorized according to the Clavien-Dindo classification \u003csup\u003e19\u003c/sup\u003e. 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 \u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e 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 \u003csup\u003e21\u003c/sup\u003e. Statistical analysis was conducted using R4.3.2 \u003csup\u003e22\u003c/sup\u003e. 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\u0026rsquo;s exact test, as appropriate. All tests were two-sided; a significant difference was considered with an alpha level\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween 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.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e 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\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe preoperative disease-specific characteristics were comparable between the two groups, as reported in Table\u0026nbsp;2, including the preoperative exposure to biologic therapies (46% vs. 50%; p\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e \u003cp\u003eIleocecal 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\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe intraoperative and postoperative surgical characteristicsare summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. 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\u0026ndash;44] vs. 40 g/L [38\u0026ndash;42], p\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e \u003cp\u003eThe operative time was significantly longer in the RG group than in the LG group (240 vs. 205 minutes; p\u0026thinsp;=\u0026thinsp;0.006), while the conversion rate was comparable (5% vs. 10%, p\u0026thinsp;=\u0026thinsp;0.49).\u003c/p\u003e \u003cp\u003ePostoperative medical and surgical complications were similar between the two groups, including the rate of intra-abdominal septic complications (5% vs. 5%, p\u0026thinsp;=\u0026thinsp;1), postoperative ileus (5% vs. 7.5%, p\u0026thinsp;=\u0026thinsp;0.71) and bleeding (2% vs. 5%, p\u0026thinsp;=\u0026thinsp;0.66). The rate of Clavien-Dindo\u0026thinsp;\u0026gt;\u0026thinsp;2 complications was also similar in the two groups (7% vs. 6%; p\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTaking 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.\u003c/p\u003e \u003cp\u003eThe 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 \u003csup\u003e23\u003c/sup\u003e, these early findings suggest that laparoscopic expertise might translate to the robotic approach yielding non-inferior outcomes using this platform.\u003c/p\u003e \u003cp\u003eNot surprisingly, a higher rate of ICAs was found in the robotic group, and similar findings were shown in previous studies \u003csup\u003e9,24,25\u003c/sup\u003e. 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 \u003csup\u003e7,8,26\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe benefits of robotic-assisted proctectomy and IPAA reported in previous studies \u003csup\u003e27–31\u003c/sup\u003e, 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.\u003c/p\u003e \u003cp\u003eThe 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).\u003c/p\u003e \u003cp\u003eIn 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.\u003c/p\u003e "},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobotic (tot = 41)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaparoscopic (tot = 80)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, Median [Q1 - Q3]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 [37.5–55.5]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 [28–54.4]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale gender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (56%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (60%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.63\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, Median [Q1 - Q3]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e–\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 [18.5–21.5]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.14\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking History\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.16\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever smoked\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (32%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (52.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuspended\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (22%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (22.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking now\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (32%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (21%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA, Median [Q1 - Q3]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.66\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious Abdominal Surgeries\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (29%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (16.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.15\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Therapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotics\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (11.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.74\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSteroids\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (15%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (24%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.33\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunomodulators\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious Biologic Therapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (63%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (47.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.14\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Biologic Therapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.51\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple Biologic Therapies\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (46%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (29%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.44\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of disease, Median [Q1 - Q3]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.33\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eBMI: body mass index, ASA: American Society of Anaesthesiologists.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;2. Crohn disease-specific characteristics\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobotic (tot = 21)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaparoscopic (tot = 42)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenetrating disease behaviour\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (29%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (43%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrent CD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplex CD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (40%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative parenteral nutrition\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative biologic therapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (46%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (50%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecurrent\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emultiple previous lines\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (34%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (29%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerianal CD requiring surgery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (14%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (14%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleal resections\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide-to-side anastomosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStapled anastomosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocecal resection\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (86%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (74%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide-to-side anastomosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStapled anastomosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (80%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eCD: Crohn’s disease; ICA: intracorporeal anastomosis\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative and postoperative surgical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobotic (tot = 41)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaparoscopic (tot = 80)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep - value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin at surgery (g/L), Median [IQR]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 [40–44]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 [38–42]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin at surgery (g/L), Median [IQR]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.5 [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 [11–13.5]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen conversion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD diagnosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (51%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (52.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUC diagnosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (49%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (47.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical intervention type\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleal or ileocecal resection alone\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (49%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (40%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocecal resection and concomitant colonic resection\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight extended colonic resection\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProctectomy and IPAA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (39%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (35%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal perineal resection\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal colectomy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.5%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of surgery (min), Median [IQR]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240 [185 − 290]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205 [150–240]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Hospital Stay (days), Median [IQR]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Medical complication\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (10%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Surgical Complication\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (20%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (17.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal septic complications\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParalytic ileus\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowel occlusion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding complication\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavien-Dindo classification \u0026gt; 2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day mortality\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eCD: Crohn’s disease; IPAA: ileo-pouch anal anastomosis; APR: abdominoperineal resection; IQR: interquartile range; UC: Ulcerative Colitis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRottoli Matteo: \u0026nbsp;Conceptualization, \u0026nbsp;Writing \u0026ndash; review \u0026amp; editing, Resources,\u0026nbsp; Funding acquisition, Supervision;\u003c/p\u003e\n\u003cp\u003eCardelli Stefano: Data curation, Formal Analysis, Writing \u0026ndash; original draft;\u003c/p\u003e\n\u003cp\u003eCalini Giacomo: Conceptualization,\u0026nbsp;Methodology, Investigation, Validation, Writing \u0026ndash; original draft, Resources;\u003c/p\u003e\n\u003cp\u003eIoana Diana Alexa: Data curation, \u0026nbsp;Writing \u0026ndash; review \u0026amp; editing;\u003c/p\u003e\n\u003cp\u003eViolante Tommaso: Writing \u0026ndash; review \u0026amp; editing;\u003c/p\u003e\n\u003cp\u003ePoggioli Gilberto: Conceptualization, Resources, Supervision,\u0026nbsp;Writing \u0026ndash; review \u0026amp; editing;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMatteo Rottoli declare the following conflict of interest: Medtronic advisory board. The other authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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 \u0026quot;HEAL ITALIA\u0026quot; to Matteo Rottoli CUP J33C22002920006.\u003c/p\u003e\n\u003cp\u003eThe views and opinions expressed are those of the authors only and do not necessarily reflect those of the European Union or the European Commission. 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PMID: 33611619\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurghgraef 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. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00384-022-04303-7\u003c/span\u003e\u003cspan address=\"10.1007/s00384-022-04303-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-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. 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Published 2023 Dec 21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00384-023-04579-3\u003c/span\u003e\u003cspan address=\"10.1007/s00384-023-04579-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-colorectal-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcd","sideBox":"Learn more about [International Journal of Colorectal Disease](http://link.springer.com/journal/384)","snPcode":"384","submissionUrl":"https://submission.nature.com/new-submission/384/3","title":"International Journal of Colorectal Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"inflammatory bowel disease, robotic surgery, robotic platform, Hugo RAS, outcome","lastPublishedDoi":"10.21203/rs.3.rs-4618724/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4618724/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of the study was to compare the perioperative outcomes of patients who underwent surgery performed through laparoscopy or using the Medtronic Hugo™ RAS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 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 \u0026lt; 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 \u0026gt; 2 complications (7% vs. 6%; p = 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIBD surgery performed using the Medtronic Hugo™ RAS is safe and feasible, with similar postoperative outcomes when compared to the laparoscopic approach.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*Matteo Rottoli \u0026amp; Stefano Cardelli are equal first authors.\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single centre experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-01 20:37:39","doi":"10.21203/rs.3.rs-4618724/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-11T12:42:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-11T12:04:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224440395942706038438404186515959243489","date":"2024-06-28T11:14:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-27T11:07:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78051638048399566529047594826936859913","date":"2024-06-27T08:12:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-26T10:09:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-24T23:38:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-24T23:37:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Colorectal Disease","date":"2024-06-21T17:23:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-colorectal-disease","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcd","sideBox":"Learn more about [International Journal of Colorectal Disease](http://link.springer.com/journal/384)","snPcode":"384","submissionUrl":"https://submission.nature.com/new-submission/384/3","title":"International Journal of Colorectal Disease","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"318f5539-5d16-498b-92e6-442937858d5f","owner":[],"postedDate":"July 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:06:08+00:00","versionOfRecord":{"articleIdentity":"rs-4618724","link":"https://doi.org/10.1007/s00384-024-04736-2","journal":{"identity":"international-journal-of-colorectal-disease","isVorOnly":false,"title":"International Journal of Colorectal Disease"},"publishedOn":"2024-10-10 15:57:58","publishedOnDateReadable":"October 10th, 2024"},"versionCreatedAt":"2024-07-01 20:37:39","video":"","vorDoi":"10.1007/s00384-024-04736-2","vorDoiUrl":"https://doi.org/10.1007/s00384-024-04736-2","workflowStages":[]},"version":"v1","identity":"rs-4618724","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4618724","identity":"rs-4618724","version":["v1"]},"buildId":"veTbxFhMMB0_faC6-Wkog","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}