Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

Table 1 Minimally Invasive techniques for inflammatory bowel diseases

Technical development	Indications1		Performed procedures	Advantages	Ref.
Laparoscopy/ laparoscopically assisted	UC	Elective surgery1 Refractory disease1 Malignancy	Proctocolectomy + IPAA	Reduced trauma Similar recovery Similar LOS Similar morbidity	[28,29,32,33]
		Urgent surgery1 High immuno-suppression1	Subtotal colectomy	Reduced trauma Faster recovery Reduced LOS	[5,23-27,31]
	CD	Primary disease1 Recurrent disease Complicated disease Stenosing disease1 Penetrating disease Fistulizing disease	Ileo-/colonic resection	Reduced trauma Faster recovery Reduced LOS Less morbidity	[11-22]
HALS	UC	Elective surgery1 Refractory disease1 Malignancy Complex cases Learning curve of lap	Proctocolectomy + IPAA Subtotal colectomy	Reduced trauma Similar recovery Similar LOS Similar morbidity Reduced operative time compared to lap Possibly less conversions to open resections compared to lap	[30,34-37]
	CD	Fistulizing disease Elective surgery1 Refractory disease1 Malignancy Complex cases	Ileo-/colonic resection	Reduced trauma Similar recovery Similar LOS Similar morbidity Reduced operative time compared to lap Possibly less conversions to open resections compared to lap	[37]
SPLS	UC	(Elective refractory disease)	Proctocolectomy + IPAA2	Fewer number of incisions Comparable morbidity2	[41-43]
	CD	Elective1 Stenosing disease1 Recurrent disease2 Disease related complications2	Ileo-/colonic resection	Shorter hospital stay compared to lap Reduced pain compared to lap Similar morbidity compared to lap	[38-40]
NOTES/NOSE	UC	-	Proctectomy	-	[54-57,59]
	CD	Perianal fistulizing disease Stenosing disease	Proctectomy Colectomy Ileocolic resections	Reduction of needed incisions for specimen removal
Trans-anal minimally invasive surgery	UC	Elective surgery1 Refractory disease1 Malignancy	Transanal proctectomy for IPAA	Transanal removal of colon with performance of anastomosis	[59]
	CD	Perianal fistulizing disease Supraanal stenosis	Transanal completion proctectomy	Transanal removal of colon with performance of anastomosis/perineal closure	[52,53,58]
Robotic surgery	UC/CD	Elective surgery1 Refractory disease1 Malignancy	Completion proctectomy following laparoscopic colectomy	Comparable postoperative morbitidy	[45-49]

¹Indicates main indications for the respective procedure; lap = multitrocar laparoscopic surgery;

²Indicates only limited evidence available. UC: Ulcerative colitis; CD: Crohn’s disease; IPAA: Ileal pouch-anal anastomosis; HALS: Hand assisted laparoscopic surgery; SPLS: Single port laparoscopic surgery; NOSE: Natural orifice specimen extraction; TAMIS: Trans-anal minimally invasive surgery; LOS: Length of stay.