Robotic versus laparoscopic surgery for IBD: a case-matched comparison during the learning curve

Robotic surgery is increasingly adopted in the management of inflammatory bowel disease (IBD), yet evidence on its safety and effectiveness during the learning phase remains limited. This study aimed to compare short-term outcomes of robotic versus laparoscopic surgery for IBD and to define the learning curve for robotic procedures during the early implementation of a robotic program in a high-volume centre. The first 50 consecutive robotic procedures performed between March 2023 and March 2025, including ileocecal resection for Crohn’s disease and restorative proctectomy with ileal pouch-anal anastomosis for ulcerative colitis, were prospectively collected and compared with a propensity-matched laparoscopic cohort selected 1:1 from a contemporaneous pool of laparoscopic cases operated by the same surgeon. Matching variables included age, sex, ASA score, BMI, diagnosis, and disease behaviour. After matching, baseline characteristics were well balanced (all standardized mean differences < 0.25). Robotic surgery resulted in longer operative times (210 ± 18 vs. 191 ± 17 min; p < 0.001) but shorter hospital stay (6.3 ± 0.7 vs. 6.9 ± 0.8 days; p < 0.001) and lower postoperative C-reactive protein peaks (161 ± 25 vs. 189 ± 27 mg/L; p < 0.001). Conversion (6% vs. 10%) and complication rates (4% vs. 6%) were comparable. CUSUM analysis identified proficiency thresholds at case 20 for ileocecal resections and case 11 for restorative proctectomies. These findings confirm that robotic surgery for IBD is safe, feasible, and associated with favourable outcomes even during early program implementation.