Abstract
Diverticulitis is a prevalent gastrointestinal disease that often warrants surgical intervention. However, the optimal approach between traditional laparoscopy (LC) and robotic-assisted laparoscopy (RAC) for diverticulitis remains unclear. Our research compares these techniques in patients diagnosed with left-sided diverticulitis treated at a single, tertiary referral center from 2019 to 2022. Among the 134 patients, 86 underwent laparoscopic and 48 robotic-assisted surgeries. The surgeries included in this analysis are left colectomy, sigmoid colectomy, low anterior resection, and Hartmann’s procedure. Primary outcomes were major morbidity and 30-day mortality. Secondary outcomes were operative time, conversion to open, length of stay, unplanned return to the operating room, 30-day readmission rate, and overall morbidity. While demographics and comorbidities were similar for both groups, the robotic-assisted group displayed a statistically significant longer operative time (198.0 ± 84.4 LC vs. 264.8 ± 78.5 min RAC, p < 0.001). When investigated further, there was a significant difference in operative time for uncomplicated diverticulitis cases favoring the LC approach (169.17 ± 58.1 LC vs. 244.82 ± 58.79 min RAC, p < 0.001). This significant difference, however, was not present in complicated diverticulitis cases. Other factors, such as overall and major morbidity, rate of conversion to open approach, ostomy creation, estimated blood loss, time to return of bowel function, length of stay, and 30-day readmission rate, did not significantly differ between the groups. There was no 30-day mortality in either group. Favorable patient outcomes, lack of significant difference in operative time compared with traditional laparoscopy, and absence of differences in morbidities or efficacy, raises an interesting question in the world of minimally invasive surgery: is the robotic-assisted approach emerging as the advantageous approach for complicated diverticulitis cases? We encourage additional, multi-center analysis of specifically complicated diverticulitis managed with both surgical approaches to investigate if these findings are replicated outside of our institution.
Similar content being viewed by others
Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity, but are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at University of South Florida.
References
Hall J, Hardiman K, Lee S et al (2020) The American Society of colon and rectal surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum 63(6):728–747. https://doi.org/10.1097/DCR.0000000000001679
Regenbogen SE, Hardiman KM, Hendren S, Morris AM (2014) Surgery for diverticulitis in the 21st century. JAMA Surg 149(3):292. https://doi.org/10.1001/jamasurg.2013.5477
Andeweg CS, Berg R, Staal JB, ten Broek RPG, van Goor H (2016) Patient-reported outcomes after conservative or surgical management of recurrent and chronic complaints of diverticulitis: systematic review and meta-analysis. Clin Gastroenterol Hepatol 14(2):183–190. https://doi.org/10.1016/j.cgh.2015.08.020
Köckerling F, Schneider C, Reymond MA et al (1999) Laparoscopic resection of sigmoid diverticulitis. Surg Endosc 13(6):567–571. https://doi.org/10.1007/s004649901042
Laurent SR, Detroz B, Detry O, Degauque C, Honoré P, Meurisse M (2005) Laparoscopic sigmoidectomy for fistulized diverticulitis. Dis Colon Rectum 48(1):148–152. https://doi.org/10.1007/s10350-004-0745-2
Vaghiri S, Prassas D, Knoefel WT, Krieg A (2022) The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis. Langenbecks Arch Surg 407(8):3259–3274. https://doi.org/10.1007/s00423-022-02698-z
Altieri MS, Yang J, Telem DA et al (2016) Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases. Surg Endosc 30(3):925–933. https://doi.org/10.1007/s00464-015-4327-2
Schootman M, Hendren S, Ratnapradipa K, Stringer L, Davidson NO (2016) Adoption of robotic technology for treating colorectal cancer. Dis Colon Rectum 59(11):1011–1018. https://doi.org/10.1097/DCR.0000000000000688
Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL (2017) Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc 31(6):2387–2396. https://doi.org/10.1007/s00464-016-5239-5
Ezekian B, Sun Z, Adam MA et al (2016) Robotic-assisted versus laparoscopic colectomy results in increased operative time without improved perioperative outcomes. J Gastrointest Surg 20(8):1503–1510. https://doi.org/10.1007/s11605-016-3124-0
Kulaylat AS, Mirkin KA, Puleo FJ, Hollenbeak CS, Messaris E (2018) Robotic versus standard laparoscopic elective colectomy: where are the benefits? J Surg Res 224:72–78. https://doi.org/10.1016/j.jss.2017.11.059
Trastulli S, Cirocchi R, Desiderio J et al (2015) Robotic versus laparoscopic approach in colonic resections for cancer and benign diseases: systematic review and meta-analysis. PLoS ONE 10(7):e0134062. https://doi.org/10.1371/journal.pone.0134062
Lorenzon L, Bini F, Balducci G, Ferri M, Salvi PF, Marinozzi F (2016) Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis. Int J Colorectal Dis 31(2):161–173. https://doi.org/10.1007/s00384-015-2394-4
Cuk P, Kjær MD, Mogensen CB, Nielsen MF, Pedersen AK, Ellebæk MB (2022) Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc 36(1):32–46. https://doi.org/10.1007/s00464-021-08782-7
Giuliani G, Guerra F, Coletta D et al (2022) Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis. Int J Colorectal Dis 37(1):101–109. https://doi.org/10.1007/s00384-021-04038-x
Larkins K, Mohan H, Apte SS et al (2022) A systematic review and meta-analysis of robotic resections for diverticular disease. Colorectal Dis 24(10):1105–1116. https://doi.org/10.1111/codi.16227
Al-Temimi MH, Chandrasekaran B, Agapian J, Peters WR, Wells KO (2019) Robotic versus laparoscopic elective colectomy for left side diverticulitis: a propensity score-matched analysis of the NSQIP database. Int J Colorectal Dis 34(8):1385–1392. https://doi.org/10.1007/s00384-019-03334-x
Bastawrous AL, Landmann RG, Liu Y, Liu E, Cleary RK (2020) Incidence, associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease. Surg Endosc 34(2):598–609. https://doi.org/10.1007/s00464-019-06804-z
**a J, Paul Olson TJ, Rosen SA (2019) Robotic-assisted surgery for complicated and non-complicated diverticulitis: a single-surgeon case series. J Robot Surg 13(6):765–772. https://doi.org/10.1007/S11701-018-00914-X/TABLES/3
Beltzer C, Knoerzer L, Bachmann R, Axt S, Dippel H, Schmidt R (2019) Robotic versus laparoscopic sigmoid resection for diverticular disease: a single-center experience of 106 cases. J Laparoendosc Adv Surg Tech 29(11):1451–1455. https://doi.org/10.1089/lap.2019.0451
Haas EM, de Paula TR, Luna-Saracho R et al (2023) The success rate of robotic natural orifice intracorporeal anastomosis and transrectal extraction (NICE procedure) in a large cohort of consecutive unselected patients. Surg Endosc 37(1):683–691. https://doi.org/10.1007/s00464-022-09717-6
Acknowledgements
The authors thank Farina Klocksieben for her valuable assistance in data analysis.
Funding
There was no grant support or financial relationship related to this study.
Author information
Authors and Affiliations
Contributions
All authors have made substantial contributions to the research and manuscript in accordance with the defined criteria. Jetsen A. Rodriguez-Silva, MD, has contributed significantly to the conception and design, acquisition of data, and analysis and interpretation of data. William Doyle, Ashley Alden, MD, and Sharan Poonja were instrumental in acquiring, analyzing, and interpreting data. Carolina Martinez, MD, Allen Chudzinski, MD, and Jorge Marcet, MD, focused their efforts on analyzing and interpreting the data. Robert D. Bennett, MD, provided critical input into the conception and design, analysis, and interpretation of data in the study. All authors have actively engaged in drafting the article and revising it critically for important intellectual content. Furthermore, they have all given final approval for the version to be published, meeting all three specified conditions of authorship credit.
Corresponding author
Ethics declarations
Conflict of interest
Dr. R. Bennett has declared his affiliations with the SAGES Robotics Committee and the SAGES Colorectal Committee. Dr. A. Chudzinski has connections with Intuitive Surgical and Baxter Surgical, having served as a speaker and consultant. Dr. J. Marcet has disclosed that he received consulting payments from companies such as Stryker, Medtronic, and Baxter and lecture fees from Intuitive Surgical. Dr. C. Martinez is participating in research sponsored by Medtronic. The remaining authors, Dr. J. Rodriguez-Silva, Dr. A. Alden, W. Doyle, and S. Poonja, affirm they have no financial or other conflicts of interest to declare.
Prior presentation
This study was presented as an ePoster at the American Society of Colon and Rectal Surgeons (ASCRS) 2023 Annual Scientific Meeting, held in Seattle, WA, from June 3 to 6, 2023.
Contribution of each author
All the authors have made substantial contributions to the research and manuscript in accordance with the defined criteria. Jetsen A. Rodriguez-Silva, MD, has contributed significantly to the conception and design, acquisition of data, and analysis and interpretation of data. William Doyle, Ashley Alden, MD, and Sharan Poonja were instrumental in acquiring, analyzing, and interpreting data. Carolina Martinez, MD, Allen Chudzinski, MD, and Jorge Marcet, MD, focused their efforts on analyzing and interpreting the data. Robert D. Bennett, MD, provided critical input into the conception and design, analysis, and interpretation of data in the study. All the authors have actively engaged in drafting the article and revising it critically for important intellectual content. Furthermore, they have all given final approval for the version to be published, meeting all three specified conditions of authorship credit.
Ethical approval
This study, performed in alignment with the principles of the Declaration of Helsinki, was granted an exemption by the Institutional Review Board (IRB) of our institution. Given the retrospective nature of the study, it did not necessitate direct interaction with human subjects or impact their care. Hence, the requirement for ethical approval was waived.
Consent to participate
Formal consent from the patients was not required for this study.
Consent for publication
Formal consent from the patients was not required for this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rodriguez-Silva, J.A., Doyle, W., Alden, A. et al. Laparoscopic vs. robotic colectomy for left-sided diverticulitis. J Robotic Surg 17, 2823–2830 (2023). https://doi.org/10.1007/s11701-023-01719-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-023-01719-3