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

Xia, Julia; Olson, Terrah J. Paul; Rosen, Seth

doi:10.1007/s11701-018-00914-x

Cited by 12 publications

(25 citation statements)

References 32 publications

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“…The inflammatory process often results in poor visualization, distorted anatomy and peritoneal adhesions [11,16,17]. These factors lead to inability to identify safe planes of dissection, difficulty manipulating tissue and cumbersome bleeding [9,10]. Furthermore, the presence of fistulas, strictures, chronic abscesses and enlarged surgical specimens have been associated with failure in extracting the specimen transrectally [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…We have since expanded this approach to more challenging procedures such as complicated diverticulitis. These cases are technically difficult when performed laparoscopically as evidenced by conversion rates reported as high as 22.2–30% [ 9 , 10 ]. The inflammatory process often results in poor visualization, distorted anatomy and peritoneal adhesions [ 11 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…We have since expanded our utilization of the robotic NICE procedure to more technically challenging cases involving complicated diverticulitis. These procedures are known to involve an inflammatory process with thickened mesentery, distorted pelvic anatomy, obliterated tissue planes and high conversion rates [9][10][11]. As such, modifications and refinements of the technique are necessary to successfully complete the NICE approach.…”

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confidence: 99%

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Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

et al. 2021

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Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

et al. 2021

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“…To the best of our knowledge, the only other case series examining robotic surgery in diverticulitis is presented by Xia et al 5 . in their 2018 paper.…”

Section: Discussionmentioning

confidence: 99%

Robotic‐assisted surgery for complicated and uncomplicated diverticulitis: A single‐surgeon case‐series comparison

Lai

Horsey

Habboosh

et al. 2021

Robotics Computer Surgery

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Background Robotic‐assisted techniques in colorectal surgery have dramatically increased. Comparative data on the management of uncomplicated and complicated diverticulitis using robotics is lacking. The purpose of this study is to examine outcomes of patients who underwent robotic‐assisted resection in diverticulitis. Methods A prospectively maintained database performed by a single surgeon was retrospectively reviewed to identify patients who underwent robotic‐assisted surgery (RAS) for diverticulitis from October 2009 to November 2018. Demographic data, preoperative and intraoperative parameters and postoperative outcomes were assessed using χ2 or Fisher exact test with p values <0.05 considered significant. IRB approval was obtained for this study, #NCR190935. Results Comparison revealed significant differences in operative times (222 vs. 291 min, p < 0.00001), mean estimated blood loss (130 vs. 304 cc, p = 0.0003) and mean length of stay (3.9 vs. 5.0 days, p = 0.006). Low rates of postoperative complications were observed, with no significant differences noted for conversion to laparoscopy, surgical site infection, leak, intra‐abdominal abscess, 30‐day unplanned readmission or recurrence. Conclusion Patients with complicated diverticulitis required longer operative time, had increased estimated blood loss and more often converted to an open procedure; however, overall rates of post‐operative complications were low in both groups. RAS shows promise for use in complicated diverticulitis.

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“…Existen múltiples reportes de reparaciones asistidas por robot de fístulas rectovaginales por enfermedad diverticular o incluso fístulas colovesicales. 29,30 Sin embargo, en este caso fue realizado el desmantelamiento de una colostomía y restitución de tránsito intestinal con resección de fístula con cierre primario sin ninguna complicación.…”

Section: Discussionunclassified

Primeros 230 casos en cirugía general asistida por robot por un solo grupo quirúrgico en México

Osorio¹,

Adame²,

García³

et al. 2020

Revista Mexicana De Cirugía Endoscópica

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La cirugía robótica cada día se encuentra más disponible y en algunos ejemplos supera a los otros abordajes quirúrgicos, brindando mejores resultados para los pacientes. El presente estudio describe la experiencia de un solo grupo quirúrgico en cirugía general, en dos centros hospitalarios privados de tercer nivel en la Ciudad de México. Material y métodos: De enero de 2016 a agosto de 2020, 230 pacientes con diferentes enfermedades se sometieron a intervención robótica dentro de la especialidad de cirugía general, las operaciones se realizaron por un solo cirujano calificado. Los resultados quirúrgicos se registraron en una base de datos. Resultados: Se sometieron a cirugía robótica 230 pacientes, 44% (102) fueron mujeres y 56% (128) fueron hombres, cuya edad promedio era de 56.5 años, con un rango de 19-88 años. La cirugía de hiato fue la más realizada en este periodo, acumulando 100 intervenciones (43.5% del total), seguida por las plastias inguinales, que sumaron 98 (42.6%), plastias ventrales 13 (5.7%), colectomías 10 (4.3%), colecistectomías 4 (1.7%), gastrectomías 3 (1.4%), resección de lesión duodenal 1 (0.4%) y restitución del tránsito intestinal con resección de fístula colovaginal 1 . El tiempo quirúrgico promedio fue de 178.4 min. Sólo existió una conversión a cirugía abierta y no se reportó ninguna complicación mayor con una morbilidad de 4.7%. Conclusiones: La cirugía robótica se está realizando con éxito y ofrece resultados comparables a los centros de excelencia internacional y existe una línea del tiempo en la experiencia del cirujano robótico que permite, conforme acumula un número de eventos y experiencia en el equipo quirúrgico, aumentar la complejidad de sus casos. En México, la evolución de la cirugía de mínimo acceso se hace presente, permaneciendo a la vanguardia en el manejo quirúrgico.

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

Cited by 12 publications

References 32 publications

Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

Robotic‐assisted surgery for complicated and uncomplicated diverticulitis: A single‐surgeon case‐series comparison

Primeros 230 casos en cirugía general asistida por robot por un solo grupo quirúrgico en México

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