Robotic Surgery: Advances in the Treatment of Diverticulitis

摘要

Introduction: The incidence of diverticulitis in the United States is on the rise, with studies showing a 26% increase in hospital admissions and a 29% increase in elective operations from 1998 to 2005. The recommended treatment for recurrent or complicated diverticulitis is surgical resection. Randomized controlled studies have shown that laparoscopic colon resection is associated with shorter hospital stay and decreased postoperative pain when compared to open procedures. Despite this, only 25% of colorectal surgery is done laparoscopically, with conversion rates to open as high as 20-25%. This is due to the steep learning curve and difficult dissection in the pelvis. There has been much controversy over the use of the robot in surgery because of financial costs. However, its use in colorectal surgery may allow more cases to be done minimally invasively and lead to better patient outcomes. Aim: To review conversion rates, outcomes and financial cost of robotic colorectal surgery for the treatment of diverticulitis at a single university medical center. Methods: Retrospective review of robotic cases performed at Rutgers RWJ for diverticulitis from 2009 to 2013. Patient characteristics, conversion rates, length of stay, postoperative complications, and financial costs were evaluated. The latter were compared to laparoscopic cases. Results: Thirty-one patients underwent robotic surgery for diverticulitis. One presented with a colovesicular fistula and 1 with a colovaginal fistula; 74% of patients were female and 26% were male. Average BMI was 28.9 kg/m2. Average age was 50.9 years. Twenty-six patients had low anterior resections (LAR), 2 had LARs with takedown of fistula, and 3 had sigmoidectomies. There was a 0% conversion rate and no mortalities. Average length of stay was 3.9 days. No patients reported sexual dysfunction. Three patients had complications, 1 postoperative ileus, 1 wound infection, and 1 developed ARDS and AKI, but had a complete recovery. Robotic LARs had a 0.4-day decrease in length of stay and an increased net profit of $3,090.80 per case compared to laparoscopic LARs. Conclusion: Robotic surgery for diverticular disease can be performed safely and effectively. Conversion and complication rates appear improved when compared to traditional laparoscopy, possibly due to better visualization and dexterity achieved with the robot. Financial analysis at our institution reveals that use of the robot was not more expensive compared to laparoscopy, and preliminary data suggests there maybe a cost benefit with use of the robot. Our results suggest that use of the robot may allow surgeons to perform more minimally invasive cases, with less morbidity compared to laparoscopy. Robotic surgery merits strong consideration for the surgical treatment of diverticulitis.