Department of General Surgery, Austin Health, Melbourne, Victoria, Australia.
General Surgery Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia.
ANZ J Surg. 2023 Jun;93(6):1626-1630. doi: 10.1111/ans.18259. Epub 2023 Jan 11.
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.
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.
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.
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.
机器人结直肠手术是一种以微创方式进行复杂手术的方法。在憩室病中，慢性炎症会使组织平面模糊，增加切除的难度。本研究旨在通过回顾一系列憩室切除术的短期结果，评估机器人方法在憩室病中的应用的可行性和安全性。
2016 年 6 月至 2022 年 6 月，墨尔本的三个中心对 41 例憩室病患者进行了机器人结直肠手术。收集了人口统计学、手术和临床病理数据。采用描述性统计评估主要和次要结果。对简单和复杂憩室病进行了比较分析，以确定两组在短期结果方面的差异。本研究的主要结果是确定从微创手术转为开放手术的转化率。次要结果包括主要并发症发生率和住院时间。
41 例患者中，24 例（58.5%）为单纯性疾病，17 例（41.5%）为复杂性疾病。1 例（2.4%）患者需要转为开放性切除。复杂性疾病的中位住院时间为 7 天，单纯性疾病为 5 天（P=0.05）。发生 4 例外科 Clavien-Dindo III 级或以上并发症，1 例患者需要返回手术室。无吻合口漏或需要放射引流的积液。13 例患者（31.7%）接受输尿管支架置入术和术中吲哚菁绿染料输尿管识别。
本系列机器人憩室切除术是安全的，转化率为 2.4%。机器人复杂疾病的切除是可行的，安全性可接受。
