A retrospective audit of robotic versus laparoscopic anterior resection for diverticular disease in a single surgeon’s experience
DOI:
https://doi.org/10.18203/2349-2902.isj20231721Keywords:
Anterior resection, Diverticulitis, Diverticular disease, Laparoscopic, Minimally invasive surgery, RoboticAbstract
Background: There has been a shift towards elective resection for recurrent or complicated diverticular disease to prevent recurrent episodes of diverticulitis. Our study aims to compare the outcomes in elective robotic and laparoscopic anterior resection for diverticular disease by a single surgeon experienced in both techniques.
Methods: This is a retrospective study of patients who underwent elective anterior resections at Nepean Public Hospital, Nepean Private Hospital, and Sydney Adventist Hospital (SAN) in the last 10 years. The single surgeon is an experienced surgeon who has performed laparoscopic anterior resections from January 2013 to December 2018; and mainly robotic anterior resections from January 2018 to July 2022. The primary outcome of this study was to determine if there were any differences in length of stay and post-operative complications in laparoscopic and robotic anterior resections. Secondary outcome measures included operating time, rate of conversion to open surgery, and 30-day mortality and morbidity.
Results: There were 53 patients included in this study. There was no significant difference in conversion to open rates (p=0.528), mean operative time (p=0.095), stoma formation rates (p=0.528) and post-operative complication rates (0.609). Length of stay was significantly shorter in the robotic group (p=0.024), and a higher proportion of patients who had laparoscopic surgery stayed for ≥6 days (p=0.08). There were no anastomotic leakages, or 30-day mortality and morbidity.
Conclusions: Robotic anterior resection is a feasible approach in experienced hands and produces comparable results to laparoscopic anterior resection for diverticular disease in terms of length of stay, post-operative complications, and operative timings.
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References
Vaghiri S, Jagalla DM, Prassas D, Knoefel WT, Krieg A. Early elective versus elective sigmoid resection in diverticular disease: not only timing matters-a single institutional retrospective review of 133 patients. Langenbeck's arch Surg. 2022;407(4):1613-23.
Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J, et al. Complicated diverticulitis: is it time to rethink the rules? Ann Surg. 2005;242(4):576-81.
Giuliani G, Guerra F, Coletta D, Giuliani A, Salvischiani L, Tribuzi A, et al. Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis. Int J Color Dis. 2022;37(1):101-9.
Hollis RH, Cannon JA, Singletary BA, Korb ML, Hawn MT, Heslin MJ. Understanding the value of both laparoscopic and robotic approaches compared to the open approach in colorectal surgery. J Laparoend Advan Surg Tech Part A. 2016;26(11):85-856.
Hettiarachchi TS, Askari A, Rudge E, Hao LT, Sarwar S, Dowsett D, et al. Comparison of robotic vs laparoscopic left-sided colorectal cancer resections. J Robot Surg. 2023;17(1):205-13.
Angehrn FV, Schneider R, Wilhelm A, Daume D, Koechlin L, Fourie L, et al. Robotic versus laparoscopic low anterior resection following neoadjuvant chemoradiation therapy for stage II–III locally advanced rectal cancer: a single-centre cohort study. J Robo Surg. 2022;16(5):1133-41.
del Gutiérrez Delgado MP, Mera Velasco S, Turiño Luque JD, González Poveda I, Ruiz López M, Santoyo J. Outcomes of robotic-assisted vs conventional laparoscopic surgery among patients undergoing resection for rectal cancer: an observational single hospital study of 300 cases. J Robot Surg. 2021;16(1):179-87.
Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: The ROLARR Randomized Clinical Trial. JAMA. 2017;318(16):1569-80.
Cassini D, Depalma N, Grieco M, Cirocchi R, Manoochehri F, Baldazzi G. Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure. Surg Endos. 2019;33(8):2583-90.
Larkins K, Mohan H, Apte SS, Chen V, Rajkomar A, Larach JT, Smart P, Heriot A, Warrier S. A systematic review and meta‐analysis of robotic resections for diverticular disease. Colorectal Disease. 2022;24(10):1105-16.
Deutsch GB, Sathyanarayana SA, Gunabushanam V, Mishra N, Rubach E, Zemon H, et al. Robotic vs. laparoscopic colorectal surgery: an institutional experience. Surg Endos. 2012;26(4):956-63.
Mégevand JL, Lillo E, Amboldi M, Lenisa L, Ambrosi A, Rusconi A. TME for rectal cancer: consecutive 70 patients treated with laparoscopic and robotic technique-cumulative experience in a single centre. Upd Surg. 2019;71(2):331-8.
Crippa J, Grass F, Dozois EJ, Mathis KL, Merchea A, Colibaseanu DT, et al. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort. Ann Surg. 2020;274(6):E1218-E22.
Gass JM, Daume D, Schneider R, Steinemann D, Mongelli F, Scheiwiller A, et al. Laparoscopic versus robotic-assisted, left-sided colectomies: intra- and postoperative outcomes of 683 patients. Surg Endos. 2022;36(8):6235-42.
Myrseth E, Nymo LS, Gjessing PF, Kørner H, Kvaløy JT, Norderval S. Lower conversion rate with robotic assisted rectal resections compared with conventional laparoscopy; a national cohort study. Surg Endos. 2021;36(5):3574-84.
Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134-44.
Parascandola SA, Horsey ML, Hota S, Paull JO, Graham A, Pudalov N, et al. The robotic colorectal experience: an outcomes and learning curve analysis of 502 patients. Colorectal Dis. 2021;23(1):226-36.
Melich G, Hong YK, Kim J, Hur H, Baik SH, Kim NK, et al. Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg Endosc. 2015;29(3):558-68.
Lei KY, Xie WJ, Fu SQ, Ma M, Sun T. A comparison of the da Vinci Xi vs. da Vinci Si surgical systems for radical prostatectomy. BMC Surg. 2021;21(1):409.
Kowalewski KF, Seifert L, Ali S, Schmidt MW, Seide S, Haney C, et al. Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis. Surg Endos. 2020;35(1):81-95.
Phan K, Kahlaee HR, Kim SH, Toh JWT. Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol. 2019;23(3):221-30.
Donlon NE, Nugent TS, Free R, Hafeez A, Kalbassi R, Neary PC, et al. Robotic versus laparoscopic anterior resections for rectal and rectosigmoid cancer: an institutional experience. J Med Sci. 2021;191(2):845-51.
