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

Abstract

Background: Ileal pouch–anal anastomosis (IPAA) is the standard restorative procedure for patients with ulcerative colitis requiring colectomy. Although robotic-assisted surgery has gained increasing acceptance in colorectal surgery, its role in IPAA remains uncertain. Methods: A systematic search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to May 2026. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I 2 statistic. Sensitivity analyses were conducted to analyze outcomes with moderate or substantial heterogeneity. Results: Six comparative observational studies involving 946 patients were included; 460 underwent robotic-assisted IPAA, and 486 underwent laparoscopic IPAA. No significant differences were observed between approaches regarding anastomotic leak (OR: 0.69; 95% CI: 0.37 to 1.28; P = .234), bleeding (OR: 0.59; 95% CI: 0.21 to 1.64; P = .309), Clavien–Dindo grade III or higher complications (OR: 1.17; 95% CI: 0.57 to 2.41; P = .670), conversion to open surgery (OR: 0.46; 95% CI: 0.16 to 1.34; P = .156), postoperative ileus (OR: 1.11; 95% CI: 0.65 to 1.91; P = .705), overall morbidity (OR: 1.17; 95% CI: 0.84 to 1.63; P = .361), reoperation (OR: 1.06; 95% CI: 0.27 to 4.19; P = .933), or 30-day readmission (OR: 0.83; 95% CI: 0.59 to 1.17; P = .278). Likewise, no significant differences were identified in operative time (MD 26.3 minutes; 95% CI: −1.9 to 54.4; P = .07) or hospital stay (MD −0.5 days; 95% CI: −1.5 to 0.5; P = .34). Sensitivity analyses did not materially alter the direction or statistical significance of the pooled estimates despite moderate to high heterogeneity in selected outcomes. Conclusion: Available observational evidence suggests that robotic-assisted IPAA yields short-term outcomes comparable to those of laparoscopic IPAA; however, the certainty of evidence is very low, and definitive conclusions are constrained by the observational nature of the available data.