Abstract
Robotic abdominal surgery is growing despite a paucity of clinical reports to evaluate its impact on patient outcomes. In this retrospective case series, we aim to analyze our early experience with robotic resection in 11 consecutive patients with chronic colonic diverticulitis complicated by fistula to bladder, vagina, or skin and to compare the results of the robotic approach to 20 patients undergoing laparoscopic resection for the same indication. Our main outcome measures include operative time, blood loss, conversion rate, transfusion rate, hospital length of stay, complications, readmission, and fistula healing rate. In our study, we found robotic resection for colonic diverticulitis with fistula was technically feasible and yielded 100 % fistula healing rate. The operative time, complication and readmission rates were similar to laparoscopy. A higher conversion rate, diverting stoma need, and longer hospital length of stay were noted in the robotic group; however, these findings could have been attributed to a higher number of cases involving rectal excision in the robotic group. Larger studies are needed to further examine the impact of robotic surgery on the outcome of patients with complicated chronic sigmoid diverticulitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, Ringel Y, Kim HP, Dibonaventura MD, Carroll CF, Allen JK, Cook SF, Sandler RS, Kappelman MD, Shaheen NJ (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143(5):1179–1187. doi:10.1053/j.gastro.2012.08.002 e1171–1173
Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217. doi:10.1097/SLA.0b013e3181952888
Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL (1988) Internal fistulas in diverticular disease. Dis Colon Rectum 31(8):591–596
Zehetner J, Szabo K, Wayand W, Shamiyeh A (2009) Lessons learned from the analysis of 200 laparoscopic sigmoid resections for diverticulitis. Surg Laparosc Endosc Percutan Tech 19(2):123–127. doi:10.1097/SLE.0b013e3181a091eb
Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G (1997) Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 11(10):1021–1025
Berthou JC, Charbonneau P (1999) Elective laparoscopic management of sigmoid diverticulitis. Results in a series of 110 patients. Surg Endosc 13(5):457–460
Kockerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J, Bruch HP, Zornig C, Kohler L, Barlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13(6):567–571
Smadja C, Sbai Idrissi M, Tahrat M, Vons C, Bobocescu E, Baillet P, Franco D (1999) Elective laparoscopic sigmoid colectomy for diverticulitis. Results of a prospective study. Surg Endosc 13(7):645–648
Letarte F, Hallet J, Drolet S, Charles Gregoire R, Bouchard A, Gagne JP, Thibault C, Bouchard P (2013) Laparoscopic emergency surgery for diverticular disease that failed medical treatment: a valuable option? Results of a retrospective comparative cohort study. Dis Colon Rectum 56(12):1395–1402. doi:10.1097/DCR.0b013e3182a760b6
Abbass MA, Tsay AT, Abbas MA (2013) Laparoscopic resection of chronic sigmoid diverticulitis with fistula. JSLS 17(4):636–640. doi:10.4293/108680813X13693422520512
Royds J, O’Riordan JM, Eguare E, O’Riordan D, Neary PC (2012) Laparoscopic surgery for complicated diverticular disease: a single-centre experience. Colorectal Dis 14(10):1248–1254. doi:10.1111/j.1463-1318.2011.02924.x
Liao G, Zhao Z, Lin S, Li R, Yuan Y, Du S, Chen J, Deng H (2014) Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol 12:122. doi:10.1186/1477-7819-12-122
Kim CW, Kim CH, Baik SH (2014) Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 18(4):816–830. doi:10.1007/s11605-014-2469-5
Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2010) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 12(11):1084–1093. doi:10.1111/j.1463-1318.2009.01999.x
Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, Breukink S (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200. doi:10.1002/14651858.CD005200.pub3
Bordeianou L, Rattner D (2010) Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology 138(7):2213–2216. doi:10.1053/j.gastro.2010.04.027
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246(4):655–662. doi:10.1097/SLA.0b013e318155a762 (discussion 655–662)
Ragupathi M, Ramos-Valadez DI, Patel CB, Haas EM (2011) Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature. Surg Endosc 25(1):199–206. doi:10.1007/s00464-010-1159-y
Maciel V, Lujan HJ, Plasencia G, Zeichen M, Mata W, Jorge I, Lee D, Viamonte M 3rd, Hartmann RF (2014) Diverticular disease complicated with colovesical fistula: laparoscopic versus robotic management. Int Surg 99(3):203–210. doi:10.9738/INTSURG-D-13-00201.1
Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN (2010) Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg 252(2):254–262. doi:10.1097/SLA.0b013e3181e6239e
Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226. doi:10.1002/bjs.8841
Xu H, Li J, Sun Y, Li Z, Zhen Y, Wang B, Xu Z (2014) Robotic versus laparoscopic right colectomy: a meta-analysis. World J Surg Oncol 12(1):274. doi:10.1186/1477-7819-12-274
Alasari S, Min BS (2012) Robotic colorectal surgery: a systematic review. ISRN Surg 2012:293894. doi:10.5402/2012/293894
Acknowledgments
Elisabeth McLemore would like to disclose the following: Applied Medical: speaking/teaching honorarium, research funding, symposium grant funding. Covidien: consultant honorarium, symposium grant funding. Cubist: speakers bureau, personal stock holding. Ethicon Endosurgery: speaking/teaching honorarium. Genomic Health: speakers bureau. Intuitive Surgical: consultant honorarium, proctor honorarium. Novadaq: speaking/teaching honorarium, consultant honorarium. Novatract: symposium grant funding. Stryker Endoscopy: symposium grant funding.
Conflict of interest
Peter Elliott, Mohmmad Abbass and Maher Abbas declare that they have no conflict of interest.
Ethical standard
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Elliott, P.A., McLemore, E.C., Abbass, M.A. et al. Robotic versus laparoscopic resection for sigmoid diverticulitis with fistula. J Robotic Surg 9, 137–142 (2015). https://doi.org/10.1007/s11701-015-0503-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-015-0503-6