Reduced conversion and readmission rates in robotic ileocecal resection for Crohn’s disease: a propensity-matched analysis of the Hugo™ RAS system

BACKGROUND: Robotic surgery is increasingly adopted in inflammatory bowel disease to address the technical limitations of conventional laparoscopy. This study aimed to compare the perioperative outcomes of robotic ileocecal resection for Crohn's disease (CD) using the Hugo™ RAS system against laparoscopic and open approaches. METHODS: Data were retrospectively collected from a prospectively maintained database of patients undergoing ileocecal resection for CD between January 2003 and June 2025 at a tertiary referral center. Patients were stratified by surgical approach: robotic, laparoscopic, or open. Multivariable regression, 1:1 and 1:4 propensity score matching (PSM), and G-computation were utilized to compare postoperative complications, readmissions, conversion rates, and length of hospital stay (LOS). RESULTS: A total of 1392 patients were included (62 robotic, 623 laparoscopic, 707 open). The robotic approach was associated with a significantly lower rate of conversion to open surgery compared to laparoscopy (1.6% vs 15.2%; p = 0.001). After adjustment, robotic surgery remained independently associated with an 89% reduction in the odds of conversion (adjusted OR 0.11; 95% CI 0.02-0.77; p = 0.027). In the primary PSM analysis, the robotic group demonstrated a 16.1% absolute risk reduction in 30-day readmissions (p = 0.025) and a significantly lower risk of severe complications (Clavien-Dindo ≥ III) compared to laparoscopy (p = 0.037). Sensitivity analyses confirmed a statistically significant reduction in LOS for the robotic group compared to both laparoscopic (p = 0.049) and Open (p < 0.001) approaches. Adjusted operative times were comparable between robotic and laparoscopic procedures (p = 0.572). CONCLUSION: Robotic ileocecal resection using the Hugo™ RAS system is a safe and effective alternative to conventional techniques. It offers distinct clinical advantages, including marked reductions in conversion rates and hospital readmissions, as well as a shorter length of stay, without compromising operative efficiency.