Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
University of South Florida Morsani College of Medicine, Tampa, FL, USA.
J Robot Surg. 2023 Dec;17(6):2823-2830. doi: 10.1007/s11701-023-01719-3. Epub 2023 Sep 24.
Diverticulitis is a prevalent gastrointestinal disease that often warrants surgical intervention. However, the optimal approach between traditional laparoscopy (LC) and robotic-assisted laparoscopy (RAC) for diverticulitis remains unclear. Our research compares these techniques in patients diagnosed with left-sided diverticulitis treated at a single, tertiary referral center from 2019 to 2022. Among the 134 patients, 86 underwent laparoscopic and 48 robotic-assisted surgeries. The surgeries included in this analysis are left colectomy, sigmoid colectomy, low anterior resection, and Hartmann's procedure. Primary outcomes were major morbidity and 30-day mortality. Secondary outcomes were operative time, conversion to open, length of stay, unplanned return to the operating room, 30-day readmission rate, and overall morbidity. While demographics and comorbidities were similar for both groups, the robotic-assisted group displayed a statistically significant longer operative time (198.0 ± 84.4 LC vs. 264.8 ± 78.5 min RAC, p < 0.001). When investigated further, there was a significant difference in operative time for uncomplicated diverticulitis cases favoring the LC approach (169.17 ± 58.1 LC vs. 244.82 ± 58.79 min RAC, p < 0.001). This significant difference, however, was not present in complicated diverticulitis cases. Other factors, such as overall and major morbidity, rate of conversion to open approach, ostomy creation, estimated blood loss, time to return of bowel function, length of stay, and 30-day readmission rate, did not significantly differ between the groups. There was no 30-day mortality in either group. Favorable patient outcomes, lack of significant difference in operative time compared with traditional laparoscopy, and absence of differences in morbidities or efficacy, raises an interesting question in the world of minimally invasive surgery: is the robotic-assisted approach emerging as the advantageous approach for complicated diverticulitis cases? We encourage additional, multi-center analysis of specifically complicated diverticulitis managed with both surgical approaches to investigate if these findings are replicated outside of our institution.
憩室炎是一种常见的胃肠道疾病，常需手术干预。然而，对于憩室炎的传统腹腔镜（LC）和机器人辅助腹腔镜（RAC）治疗，哪种方法更优尚不清楚。我们的研究比较了 2019 年至 2022 年在一家三级转诊中心接受治疗的左侧憩室炎患者的这两种技术。在 134 名患者中，86 例行腹腔镜手术，48 例行机器人辅助手术。本分析纳入的手术包括左结肠切除术、乙状结肠切除术、低位前切除术和 Hartmann 手术。主要结局为主要发病率和 30 天死亡率。次要结局为手术时间、中转开腹、住院时间、非计划返回手术室、30 天再入院率和总发病率。虽然两组患者的人口统计学和合并症相似，但机器人辅助组的手术时间明显更长（LC 组为 198.0±84.4 分钟，RAC 组为 264.8±78.5 分钟，p<0.001）。进一步研究发现，对于单纯性憩室炎病例，LC 组的手术时间明显更短（LC 组为 169.17±58.1 分钟，RAC 组为 244.82±58.79 分钟，p<0.001）。然而，在复杂性憩室炎病例中，这种差异并不显著。其他因素，如总发病率和主要发病率、中转开腹率、造口术、估计失血量、肠功能恢复时间、住院时间和 30 天再入院率，两组间无显著差异。两组均无 30 天死亡率。患者结局良好，与传统腹腔镜相比手术时间无显著差异，且发病率和疗效无差异，这在微创外科领域提出了一个有趣的问题：机器人辅助方法是否成为复杂性憩室炎病例的有利治疗方法？我们鼓励对采用这两种手术方法治疗的特定复杂性憩室炎进行更多的、多中心的分析，以研究这些发现是否在我们机构之外得到复制。
