Robotic surgery for Crohn’s disease: multinational survey of colorectal surgeons

Robotic-assisted surgery is increasingly utilised in colorectal procedures, yet its adoption in Crohn’s disease (CD) remains limited. Challenges unique to CD—such as complex anatomy, prior operations, and inflammation—present substantial barriers to robotic integration, compounded by the absence of standardised operative strategies. We aimed to evaluate current global practices among colorectal surgeons regarding robotic ileocolic resection for CD, and to propose a standardised surgical planning framework to address variability in technique and perioperative planning. A structured multinational survey was iteratively developed using validated assessment tools, targeting colorectal consultants, fellows, and senior trainees and was disseminated via professional networks. Quantitative and qualitative responses regarding port placement, dissection strategies, intraoperative decision-making, and perceived barriers were analysed. Insights were synthesised with guidelines to inform the PRESERVED framework. The survey was disseminated via professional networks to colorectal surgeons in multiple countries. Survey responses (n = 30) from eight countries—predominantly UK-based (50%) and consultants (80%). Survey responses revealed low robotic uptake in IBD compared to colorectal cancer. Common challenges included adhesions, prior surgery, and multi-segment disease; robotic access was rarely a constraint (3.3%). Despite variable approaches, intracorporeal anastomosis and Pfannenstiel extraction were favoured. The PRESERVED framework—comprising nine modular perioperative phases—was developed to guide decision-making and mitigate CD-specific surgical risks. This study is the first multinational exploration of robotic surgical practices in CD. Despite limited uptake, expert insights underscore a growing interest in robotic approaches and the need for structured guidance. The PRESERVED framework offers an evidence-based, adaptable tool to support surgical planning and training. Further validation through consensus-building and multicentre prospective studies is warranted.