Skip to main content
SpringerLink
Log in

Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robotic-assisted laparoscopic surgery has recently gained enthusiasm for application in colorectal surgery. We present the safety and feasibility of using the da Vinci® robotic system for the surgical treatment of sigmoid diverticulitis.

Methods

Between August 2008 and November 2009, robotic-assisted laparoscopic anterior rectosigmoid resection (RALS-AR) for diverticulitis was performed in 24 consecutive patients. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.

Results

RALS-AR was performed in 14 male (58.3%) and 10 female (41.7%) patients with a diagnosis of recurrent diverticulitis. The mean patient age and BMI were 49.8 ± 9.3 years (range = 30–62 years) and 29.9 ± 6.3 kg/m2 (range = 15.9–46.9 kg/m2), respectively. Disease stratification identified 15 cases of uncomplicated (62.5%) and 9 cases of complicated (37.5%) disease. The procedures required 14.1 ± 6.7 min (range = 6–30 min) for robotic docking, 100.5 ± 31.0 min (range = 50–180 min) for surgeon console time, and 224.2 ± 47.1 min (range = 150–330 min) for the total operative time. Robotic docking and surgeon console time represented 51.9% of the total operative time. A primary colorectal anastomosis was fashioned with avoidance of colostomy in all patients. There were no significant intraoperative complications, and none of the procedures required conversion to open, hand-assisted, or conventional laparoscopic technique. The length of hospital stay was 3.4 ± 2.6 days (range = 2–14 days), and the postoperative complication rate was 12.5% (n = 3). There were no anastomotic leaks, secondary surgical interventions, or hospital readmissions.

Conclusions

Robotic-assisted laparoscopic technique is a safe and feasible option for the surgical treatment of diverticulitis. The approach may be offered to patients with uncomplicated or complicated disease, and it results in a short hospital stay and low complication rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. McCafferty MH, Roth L, Jorden J (2008) Current management of diverticulitis. Am Surg 74:1041–1049

    PubMed  Google Scholar 

  2. Himal HS (2002) Minimally invasive (laparoscopic) surgery. Surg Endosc 16:1647–1652

    Article  CAS  PubMed  Google Scholar 

  3. Lau WY, Leow CK, Li AK (1997) History of endoscopic and laparoscopic surgery. World J Surg 21:444–453

    Article  CAS  PubMed  Google Scholar 

  4. Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11:264–267

    Article  CAS  PubMed  Google Scholar 

  5. Phillips EH, Franklin M, Carroll BT, Fallas M, Ramos R, Rosenthal D (1992) Laparoscopic colectomy. Ann Surg 216:703–707

    Article  CAS  PubMed  Google Scholar 

  6. Zucker KA, Pitcher DE, Martin DT, Ford RS (1994) Laparoscopic assisted colon resection. Surg Endosc 8:12–18

    Article  CAS  PubMed  Google Scholar 

  7. Hoffman GC, Baker JW, Fitchett CW, Vansant JH (1994) Laparoscopic assisted colectomy. Initial experience. Ann Surg 219:732–743

    Article  CAS  PubMed  Google Scholar 

  8. Falk PM, Beart RW Jr, Wexner SD, Thorson AG, Jagelman DG, Lavery IC, Johanson OB, Fitzgibbons RJ Jr (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36:28–34

    Article  CAS  PubMed  Google Scholar 

  9. Purkayastha S, Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Tilney H, Darzi AW, Heriot AG (2006) Laparoscopic vs. open surgery for diverticular disease: a meta-analysis of nonrandomized studies. Dis Colon Rectum 49:446–463

    Article  PubMed  Google Scholar 

  10. Amodeo A, Linares Quevedo A, Joseph JV, Belgrano E, Patel HR (2009) Robotic laparoscopic surgery: cost and training. Minerva Urol Nefrol 61:121–128

    CAS  PubMed  Google Scholar 

  11. Murphy DG, Hall R, Tong R, Goel R, Costello AJ (2008) Robotic technology in surgery: current status in 2008. ANZ J Surg 78:1076–1081

    Article  PubMed  Google Scholar 

  12. Dasgupta P, Kirby RS (2009) The current status of robot-assisted radical prostatectomy. Asian J Androl 11:90–93

    Article  PubMed  Google Scholar 

  13. Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694

    Article  PubMed  Google Scholar 

  14. Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  15. Hildebrandt U, Plusczyk T, Kessler K, Menger MD (2003) Single-surgeon surgery in laparoscopic colonic resection. Dis Colon Rectum 46:1640–1645

    Article  CAS  PubMed  Google Scholar 

  16. Jacob BP, Gagner M (2003) Robotics and general surgery. Surg Clin North Am 83:1405–1419

    Article  PubMed  Google Scholar 

  17. Rockall TA, Darzi A (2003) Robot-assisted laparoscopic colorectal surgery. Surg Clin North Am 83:1463–1468 xi

    Article  PubMed  Google Scholar 

  18. Ruurda JP, Broeders IA (2003) Robot-assisted laparoscopic intestinal anastomosis. Surg Endosc 17:236–241

    Article  CAS  PubMed  Google Scholar 

  19. Talamini MA (2003) Laparoscopy for benign disease: robotics. Semin Laparosc Surg 10:203–208

    PubMed  Google Scholar 

  20. Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T (2004) Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 14(6):311–315

    Article  PubMed  Google Scholar 

  21. D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, Guidolin D (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum 47:2162–2168

    Article  PubMed  Google Scholar 

  22. Braumann C, Jacobi CA, Menenakos C, Borchert U, Rueckert JC, Mueller JM (2005) Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences. Dis Colon Rectum 48:1820–1827

    Article  PubMed  Google Scholar 

  23. Kariv Y, Delaney CP (2005) Robotics in colorectal surgery. Minerva Chir 60:401–416

    CAS  PubMed  Google Scholar 

  24. Woeste G, Bechstein WO, Wullstein C (2005) Does telerobotic assistance improve laparoscopic colorectal surgery? Int J Colorectal Dis 20:253–257

    Article  PubMed  Google Scholar 

  25. D’Annibale A, Orsini C, Morpurgo E, Sovernigo G (2006) [Robotic surgery: considerations after 250 procedures]. Chir Ital 58:5–14 (article in Italian)

    PubMed  Google Scholar 

  26. DeNoto G, Rubach E, Ravikumar TS (2006) A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A 16:551–556

    Article  PubMed  Google Scholar 

  27. Rawlings AL, Woodland JH, Crawford DL (2006) Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 20:1713–1718

    Article  CAS  PubMed  Google Scholar 

  28. Satava RM (2006) Robotics in colorectal surgery: telemonitoring and telerobotics. Surg Clin North Am 86:927–936

    Article  PubMed  Google Scholar 

  29. Sebajang H, Trudeau P, Dougall A, Hegge S, McKinley C, Anvari M (2006) The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc 20:1389–1393

    Article  CAS  PubMed  Google Scholar 

  30. Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708

    Article  CAS  PubMed  Google Scholar 

  31. Baik SH (2008) Robotic colorectal surgery. Yonsei Med J 49:891–896

    Article  PubMed  Google Scholar 

  32. Braumann C, Jacobi CA, Menenakos C, Ismail M, Rueckert JC, Mueller JM (2008) Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech 18:260–266

    Article  PubMed  Google Scholar 

  33. Spinoglio G, Summa M, Priora F, Quarati R, Testa S (2008) Robotic colorectal surgery: first 50 cases experience. Dis Colon Rectum 51:1627–1632

    Article  PubMed  Google Scholar 

  34. Redwine D, Sharpe D (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1:217–220

    CAS  PubMed  Google Scholar 

  35. Lu CT, Ho YH (2008) Elective laparoscopic surgical management of recurrent and complicated sigmoid diverticulitis. Tech Coloproctol 12:201–206

    Article  CAS  PubMed  Google Scholar 

  36. Rotholtz NA, Montero M, Laporte M, Bun M, Lencinas S, Mezzadri N (2009) Patients with less than three episodes of diverticulitis may benefit from elective laparoscopic sigmoidectomy. World J Surg 33:2444–2447

    Article  PubMed  Google Scholar 

  37. Titu LV, Zafar N, Phillips SM, Greenslade GL, Dixon AR (2009) Emergency laparoscopic surgery for complicated diverticular disease. Colorectal Dis 11:401–404

    Article  CAS  PubMed  Google Scholar 

  38. Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck TH, Bruch HP (2004) Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbecks Arch Surg 389:97–103

    Article  CAS  PubMed  Google Scholar 

  39. Kohler L, Sauerland S, Neugebauer E (1999) Diagnosis and treatment of diverticular disease: Results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 13:430–436

    Article  CAS  PubMed  Google Scholar 

  40. Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J (1997) A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 11:139–142

    Article  CAS  PubMed  Google Scholar 

  41. Wishner JD, Baker JW Jr, Hoffman GC, Hubbard GW 2nd, Gould RJ, Wohlgemuth SD, Ruffin WK, Melick CF (1995) Laparoscopic-assisted colectomy. The learning curve. Surg Endosc 9:1179–1183

    Article  CAS  PubMed  Google Scholar 

  42. Palep JH (2009) Robotic assisted minimally invasive surgery. J Minim Access Surg 5:1–7

    Article  PubMed  Google Scholar 

  43. Ragupathi M, Patel CB, Ramos-Valadez DI, Haas EM (2010) Robotic-assisted laparoscopic “salvage” rectopexy ileoanal J-pouch prolapse. Gastroenterol Res Pract. doi:10.1155/2010/790462

  44. Lobontiu A, Loisance D (2007) Robotic surgery and tele-surgery: basic principles and description of a novel concept. J Chir 3:208–214

    Google Scholar 

  45. Sung GT, Gill IS (2001) Robotic laparoscopic surgery: a comparison of the da Vinci and Zeus systems. Urology 58:893–898

    Article  CAS  PubMed  Google Scholar 

  46. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, Jain A, Wexner S (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15:827–832

    Article  CAS  PubMed  Google Scholar 

  47. Gonzalez R, Smith CD, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ (2006) Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 49:197–204

    Article  PubMed  Google Scholar 

  48. Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45:485–490

    Article  PubMed  Google Scholar 

  49. Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum 45:1309–1314; discussion 1314–1315

    Article  PubMed  Google Scholar 

  50. Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 10:15–18

    Article  CAS  PubMed  Google Scholar 

  51. Hassan I, Cima RR, Larson DW, Dozois EJ, O’Byrne MM, Larson DR, Pemberton JH (2007) The impact of uncomplicated and complicated diverticulitis on laparoscopic surgery conversion rates and patient outcomes. Surg Endosc 21:1690–1694

    Article  PubMed  Google Scholar 

  52. Bartus CM, Lipof T, Sarwar CM, Vignati PV, Johnson KH, Sardella WV, Cohen JL (2005) Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum 48:233–236

    Article  PubMed  Google Scholar 

  53. Zapletal C, Woeste G, Bechstein WO, Wullstein C (2007) Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas. Int J Colorectal Dis 22:1515–1521

    Article  PubMed  Google Scholar 

  54. Pokala N, Delaney CP, Brady KM, Senagore AJ (2005) Elective laparoscopic surgery for benign internal enteric fistulas: a review of 43 cases. Surg Endosc 19:222–225

    Article  CAS  PubMed  Google Scholar 

  55. Kirsh GM, Hampel N, Shuck JM, Resnick MI (1991) Diagnosis and management of vesicoenteric fistulas. Surg Gynecol Obstet 173:91–97

    CAS  PubMed  Google Scholar 

  56. Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM (2006) Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis 8:347–352

    Article  CAS  PubMed  Google Scholar 

  57. Gemlo BT (2004) Elective surgical treatment of diverticulitis. Clin Colon Rectal Surg 17:183–186

    Article  PubMed  Google Scholar 

  58. Hoemke M, Treckmann J, Schmitz R, Shah S (1999) Complicated diverticulitis of the sigmoid: a prospective study concerning primary resection with secure primary anastomosis. Dig Surg 16:420–424

    Article  CAS  PubMed  Google Scholar 

  59. Regenet N, Pessaux P, Hennekinne S, Lermite E, Tuech JJ, Brehant O, Arnaud JP (2003) Primary anastomosis after intraoperative colonic lavage vs. Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18:503–507

    Article  CAS  PubMed  Google Scholar 

  60. Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE (2003) Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 186:696–701

    Article  PubMed  Google Scholar 

  61. Sakai Y, Nelson H, Larson D, Maidl L, Young-Fadok T, Ilstrup D (2001) Temporary transverse colostomy vs loop ileostomy in diversion: a case-matched study. Arch Surg 136:338–342

    Article  CAS  PubMed  Google Scholar 

  62. Gooszen AW, Gooszen HG, Veerman W, Van Dongen VM, Hermans J, Klien Kranenbarg E, Tollenaar RA (2001) Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection. Eur J Surg 167:35–39

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Drs. Ragupathi, Ramos-Valadez, and Haas and Mr. Patel have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA

    Madhu Ragupathi, Diego I. Ramos-Valadez, Chirag B. Patel & Eric M. Haas

  2. 7900 Fannin Street, Suite 2700, Houston, TX, 77054, USA

    Eric M. Haas

Authors
  1. Madhu Ragupathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diego I. Ramos-Valadez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chirag B. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric M. Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric M. Haas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ragupathi, M., Ramos-Valadez, D.I., Patel, C.B. et al. Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature. Surg Endosc 25, 199–206 (2011). https://doi.org/10.1007/s00464-010-1159-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1159-y

Keywords

Search

Navigation