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Laparoscopic vs. robotic colectomy for left-sided diverticulitis

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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.

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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.

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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.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA

    Jetsen A. Rodriguez-Silva, Carolina Martinez, Allen Chudzinski, Jorge Marcet & Robert D. Bennett

  2. University of South Florida Morsani College of Medicine, Tampa, FL, USA

    William Doyle & Sharan Poonja

  3. Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Ashley Alden

Authors
  1. Jetsen A. Rodriguez-Silva
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  2. William Doyle
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  3. Ashley Alden
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  4. Sharan Poonja
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  5. Carolina Martinez
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  6. Allen Chudzinski
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  7. Jorge Marcet
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  8. Robert D. Bennett
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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

Correspondence to Robert D. Bennett.

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.

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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

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  • DOI: https://doi.org/10.1007/s11701-023-01719-3

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