Robotic elective colectomy for diverticular disease: short‐term outcomes of 80 patients

Formisano, Giampaolo; Giuliani, Giuseppe; Salaj, Adelona; Salvischiani, Lucia; Ferraro, Luca; Luca, Martina De; Bianchi, Paolo Pietro

doi:10.1002/rcs.2204

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…Three studies were found in the literature with a similar percentage of patients with complex disease, 38%-71%. [7][8][9] These studies report a range of average operating time of 130-270 min, in this cohort 216 min, similar complication rates of 2.7%, 5% and 15%, in this cohort 9.8%, an average LOS of 3-6.4 days, in this cohort 7 days, and a conversion rate of 0%, 1.7% and 6.7%, [7][8][9] in this cohort 2.4%. A recent meta-analysis of laparoscopic and robotic data was used to compare laparoscopic data to this series.…”

Section: Discussionsupporting

confidence: 58%

“…This case series reports similar short‐term outcomes in comparison to robotic diverticular resection studies published internationally. Three studies were found in the literature with a similar percentage of patients with complex disease, 38%–71% 7–9 . These studies report a range of average operating time of 130–270 min, in this cohort 216 min, similar complication rates of 2.7%, 5% and 15%, in this cohort 9.8%, an average LOS of 3–6.4 days, in this cohort 7 days, and a conversion rate of 0%, 1.7% and 6.7%, 7–9 in this cohort 2.4%.…”

Section: Discussionsupporting

confidence: 54%

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Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short‐term outcomes

Bromley

Huang

Mohan

et al. 2023

ANZ Journal of Surgery

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Backgrounds Robotic colorectal surgery is a method of performing complex surgery in a minimally invasive manner. In diverticular disease, chronic inflammation obscures tissues planes and increases difficulty of resection. This study aims to assess feasibility and safety of application of a robotic approach to diverticular disease, by reviewing short‐term outcomes from a series of diverticular resections. Methods Forty‐one patients underwent robotic colorectal surgery for diverticular disease across three centres within Melbourne from June 2016 to June 2022. Demographic, operative, and clinicopathological data were collected. Descriptive statistics were used to evaluate primary and secondary outcomes. Comparative analysis between simple and complex diverticular disease was performed to identify differences in groups regarding short term outcomes. The primary outcome in this study is to determine conversion rate from minimally invasive to open surgery. Secondary outcomes include major complication rates and length of stay. Results Of the 41 patients, 24 (58.5%) had simple disease, and 17 (41.5%) had complex disease. One patient (2.4%) required conversion to open resection. The median length of stay for complex disease was 7 days, for simple disease 5 days (P = 0.05). Four surgical Clavien‐Dindo III or above complications occurred (9.8%), one patient required return to theatre. There were no anastomotic leaks or collections requiring radiological drainage. Thirteen patients (31.7%) underwent ureteric stenting and intraoperative indocyanine green dye ureteric identification. Conclusion Robotic diverticular resections in this series are safe and associated with a low conversion rate of 2.4%. Robotic resection of complex disease was feasible with an acceptable safety profile.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionsupporting

confidence: 54%

Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short‐term outcomes

Bromley

Huang

Mohan

et al. 2023

ANZ Journal of Surgery

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“…Eleven of the 15 included studies described the operative technique of the robotic resection utilised in the study. Ureteric stents were placed in 91 cases across six publications [14, 17, 18, 21, 24, 28]. The operating time reported for robotic cases was between 107 and 467 min with a mean of 185.9 min.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta‐analysis of robotic resections for diverticular disease

et al. 2022

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Aim: Resection of diverticular disease can be technically challenging. Tissue planes can be difficult to identify intraoperatively due to inflammation or fibrosis. Robotic surgery may improve identification of tissue planes and dissection which can facilitate difficult minimally invasive resections. This systematic review and meta-analysis evaluates the role of robotic surgery compared to laparoscopic surgery in diverticular resection. Methods:A systematic review and meta-analysis was performed in accordance with the PRISMA statement. The search was completed using PubMed, OVID MEDLINE and EMBASE. A total of 490 articles were retrieved, and studies reporting primary outcomes for robotic diverticular resection were included in the final analysis. A meta-analysis of studies comparing robotic and laparoscopic surgery was performed on rate of conversion to open surgery and complications.Results: Fifteen articles (8 cohort studies and 7 case series) reporting 3711 robotic diverticular resections were analysed. In comparison to laparoscopic, robotic surgery for diverticular disease was associated with a reduced conversion to open and a longer operating time. Meta-analysis showed robotic resection was associated with a lower conversion rate compared to laparoscopic surgery (OR: 0.57; 95% CI: 0.49-0.66, p < 0.001). There was no significant difference in grade III and above complications (OR: 0.74; 95% CI: 0.49-1.13, p = 0.17). Operating time was longer with a robotic approach (Hedge's G: 0.43; 95% CI: 0.04-0.81, p = 0.03). Conclusion:Robotic resection is a feasible and safe option in diverticular disease.Although associated with a longer operating time, robotic surgery may render diverticular disease resectable with a minimally invasive approach that would have otherwise necessitated a laparotomy. Randomised controlled data is required to better define the role of robotic surgery for diverticular disease resections.

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“…However, these studies have looked into rectal resections. In a recent large series of 80 patients who had robotic left colectomies for diverticular disease, Formisano et al [35] [37]. Another factor associated with operative time is the experience of the operating surgeon and the theatre team (scrub nurses, assistants, and other healthcare allied services within the theatre environment).…”

Section: Discussionmentioning

confidence: 99%

Left colectomy for diverticular disease - systematic review and meta-analysis comparing robotic and laparoscopic resections

Eltyeb,

Mohamedahmed,

Mills

et al. 2024

Preprint

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Backgroud: Diverticular disease affects approximately 50% of the population aged ≥ 60 and above. Twenty-five % will require surgical intervention. We aimed to compare the outcomes of left colonic resectionfor sigmoid diverticular disease by robotic and laparoscopic approaches. Our primary aim was to conduct a meta-analysis and to investigate conversion to open, stoma and complication rates between the two approaches. Methodology: A systematic review was performed according to the PRISMA guidelines. A meta-analysis was conducted using RevMan Version 5.4 software. Dichotomous outcomes were pooled with a random-effect model to estimate risk and odds ratios (OR). Prospero (reg # CRD42023440509). Results: Eight studies were thought to fulfil the eligibility criteria: 1,892 patients (49.2%) had robotic surgery, and 1,952 patients (50.84%) underwent a laparoscopic approach. There were fewer conversions to open surgery in the robotic group when compared to the laparoscopic group, [P < 0.00001] less rate of post-operative ileus [P = 0.005], less length of stay [mean difference (MD) - 0.18 P = 0.003] and fewer morbidities [P = 0.002]. There were similar rates of stoma formation [4.7%, P = 1.00], anastomotic leak [2.6% P = 0.85] and mortality [0.3% versus 0.2%, P = 0.59]. Although not significant, a shorter operative time in the robotic approach [P = 0.47]. Conclusion: Compared to laparoscopic left colectomy, robotic surgery is feasible, with a reduction in conversion to open rate, reduced morbidity, less ileus and similar rates of stoma formation, anastomotic leak and mortality. Further high-quality research needs to be done to investigate this further.

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Robotic elective colectomy for diverticular disease: short‐term outcomes of 80 patients

Cited by 6 publications

References 33 publications

Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short‐term outcomes

Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short‐term outcomes

A systematic review and meta‐analysis of robotic resections for diverticular disease

Left colectomy for diverticular disease - systematic review and meta-analysis comparing robotic and laparoscopic resections

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