Feasibility and safety of robotic resection of complicated diverticular disease
This study aimed to assess intra- and postoperative outcomes of robotic resection of left-sided complicated diverticular disease. Retrospective analysis of a prospectively maintained institutional database on consecutive patients undergoing elective robotic resection for diverticular disease (2014–2018). All procedures were performed within an enhanced recovery pathway (ERP). Demographic, surgical and ERP-related items were compared between patients with simple and complicated diverticular disease according to intra-operative presentation. Postoperative complications and length of stay were compared between the two groups. Out of 150 patients, 78 (52%) presented with complicated and the remaining 72 (48%) with uncomplicated disease. Both groups were comparable regarding demographic baseline characteristics and overall ERP compliance. Surgery for complicated disease was longer (288 ± 96 vs. 258 ± 72 min, p = 0.04) and more contaminated (≥ class 3: 57.7 vs. 23.6%, p < 0.001) with a trend to higher conversion rates (10.3 vs. 2.8%, p = 0.1). While postoperative overall complications tended to occur more often after resections for complicated disease (28.2 vs. 15.3%, p = 0.075), major, surgical and medical complications did not differ between the two groups, and median length of stay was 3 days in both settings (p = 0.19). Robotic resection of diverticular disease was feasible and safe regardless of disease presentation by the time of surgery.
KeywordsRobotic Diverticular disease Complications Enhanced recovery
Fabian Grass was supported by the Société Académique Vaudoise, Lausanne, Switzerland and by the SICPA foundation, Lausanne, Switzerland.
No funding sources to declare.
Compliance with ethical standards
Drs. Fabian Grass, Jacopo Crippa, Kellie L. Mathis, Scott R. Kelley, David W. Larson have no conflicts of interest or financial ties to disclose.
- 2.van de Wall BJM, Stam MAW, Draaisma WA, Stellato R, Bemelman WA, Boermeester MA, Broeders I, Belgers EJ, Toorenvliet BR, Prins HA, Consten ECJ (2017) Surgery versus conservative management for recurrent and ongoing left-sided diverticulitis (DIRECT trial): an open-label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2:13–22CrossRefGoogle Scholar
- 5.Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318:1569–1580CrossRefGoogle Scholar
- 15.Abraha I, Binda GA, Montedori A, Arezzo A, Cirocchi R (2017) Laparoscopic versus open resection for sigmoid diverticulitis. Cochrane Database Syst Rev 11::CD009277Google Scholar
- 24.Spinelli A, David G, Gidaro S, Carvello M, Sacchi M, Montorsi M, Montroni I (2017) First experience in colorectal surgery with a new robotic platform with haptic feedback. Colorectal Dis 20(3):228–235Google Scholar
- 25.Ben Salem MO, Mosbahi O, Khalgui M, Jlalia Z, Frey G, Smida M (2017) BROMETH: methodology to design safe reconfigurable medical robotic systems. Int J Med Robot 13Google Scholar
- 27.Pache B, Grass F, Fournier N, Hubner M, Demartines N, Hahnloser D (2018) Surgical teaching does not increase the risk of intraoperative adverse events. Int J Colorectal DisGoogle Scholar