Robotic-assisted surgery for complicated and non-complicated diverticulitis: a single-surgeon case series

Laparoscopic colectomy is the preferred approach for surgical management of non-complicated diverticulitis, with lower complication rates, shorter length of stay, and decreased narcotic use compared with open surgery. Complicated diverticulitis, characterized by abscess, fistula or stricture, is more difficult to manage with minimally invasive surgery, with reports of higher conversion rates, prolonged operative time, longer length of stay, and increased complication rates. The robotic platform may provide an alternative safe and feasible option for managing complicated diverticulitis with minimally invasive surgery. A prospectively maintained database of robotic-assisted colorectal surgery performed at our university-affiliated community hospital was used to identify consecutive patients who underwent robotic-assisted surgery for complicated or non-complicated diverticulitis. Thirty-two patients with non-complicated diverticulitis and 36 patients with complicated diverticulitis had surgery between January, 1, 2014 and September 30, 2017. The database was used to compare the two groups of patients in regard to operative time, estimated blood loss, ureteral stent usage, conversions, ostomies, pelvic drains, post-operative complications, length of stay, return of bowel function, and post-operative narcotic use. Comparison of the two groups revealed significant differences in operative times (172 vs. 196 min, p = 0.01), conversions (3.1% vs. 22.2%, p = 0.03), ostomies (9.4% vs. 33.3%, p = 0.04), and pelvic drains (3.2% vs. 28.6%, p = 0.02). No significant differences were noted for estimated blood loss, complications, return of bowel function, narcotic use, length of stay, or readmissions. Four complicated diverticulitis patients had intra-operative ureteral stents, and there were no ureteral injuries in either group. Patients with complicated diverticulitis required longer operative time, and more often required conversion, an ostomy, and a pelvic drain. Robotic-assisted surgery is safe and feasible for both non-complicated and complicated diverticulitis.