Possibilities of using robotic surgery in the elective sigmoid resections for patients with complicated diverticular disease: retrospective, single-center analysis

The article discusses the results of the use of robotic interventions in complicated diverticular disease. Aim. To evaluate the possibility of using robotic surgery in elective sigmoid resection for patients with chronic inflammatory complications of colon diverticular disease. Materials and methods. From January 2019 to December 2024, 82 elective minimally invasive interventions for colon diverticular disease were performed. 58 patients underwent laparoscopic resection of the affected area and 24 robotic resections. Results. The use of the da Vinci Si robotic system for elective surgical interventions in patients with complicated diverticular disease was comparable to the laparoscopic method in terms of operative time, conversion rate, intraoperative blood loss, postoperative complication rate, and postoperative hospital stay. Conclusion. Robotic surgery can be considered as a variant of the videoendoscopic method and can be used for elective treatment for patients with complicated diverticular disease.

1. Ardatskaya M. D., Achkasov S. I., Veselov V. V., Zarodnyuk I. V., Ivashkin V. T., Karpukhin O. Yu., Kashnikov V. N., Korotkikh N. N., Kostenko N. V., Kulovskaya D. P., Loranskaya I. D., Moskalev A. I., Sazhin A. V., Timerbulatov V. M., Trubacheva Yu. L., Frolov S. A., Shapovalyants S. G., Shelygin Yu. A., Shifrin O. S., Yartsev P. A. Diverticular disease. Koloproktologiya = Coloproctology. 2021; 20 (3): 10–27.

2. Shelygin Yu. A., Ivashkin V. T., Achkasov S. I., Moskalev A. I., Тimerbulatov V. M., Sazhin A. V., Shapovalyants S. G., Karpukhin O. Y., Kostenko N. V., Кorotkikh N. N., Zarodnyuk I. V., Trubacheva J. L., Veselov V. V., Likutov A. A., Kashnikov V. N., Frolov S. A., Yartsev P. A., Loranskaya I. D., Vykova B. A., Shifrin O. S., Poluektova E. A., Mamieva Z. A., Ulyanin A. I., Shkurko T. V. Clinical Guidelines Diverticular disease (57.2, 57.3), adults. Koloproktologia = Coloproctology. 2024; 23 (2): 10–27.

3. Regenbogen S. E., Hardiman K. M., Hendren S., Morris A. M. Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surgery. 2014 Mar; 149 (3): 292–303.

4. Andeweg C. S., Mulder I. M., Felt-Bersma R. J., Verbon A., van der Wilt G. J., van Goor H., Lange J. F., Stoker J., Boermeester M. A., Bleichrodt R. P.; Netherlands Society of Surgery; Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health echnology Assessment and Dieticians. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Digestive Surgery. 2013; 30 (4–6): 278–292.

5. Dalby H. R., Erichsen R., Gotschalck K. A., Emmertsen K. J. Colonic resection and stoma formation due to chronic diverticular disease: nationwide population-based cohort study. BJS Open. 2025 Mar 4; 9 (2): zraf008.

6. Hall J., Hardiman K., Lee S., Lightner A., Stocchi L., Paquette I. M., Steele S. R., Feingold D. L.; Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Diseases of the Colon & Rectum. 2020 Jun; 63 (6): 728–747.

7. Bolkenstein H. E., Consten E. C. J., van der Palen J., van de Wall B. J. M., Broeders I. A. M. J., Bemelman W. A., Lange J. F., Boermeester M. A., Draaisma W. A.; Dutch Diverticular Disease (3D) Collaborative Study Group. Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT-Trial). Annals of Surgery. 2019 Apr; 269 (4): 612–620.

8. Abraha I., Binda G. A., Montedori A., Arezzo A., Cirocchi R. Laparoscopic versus open resection for sigmoid diverticulitis. Cochrane Database of Systematic Reviews. 2017 Nov 25; 11 (11): CD009277.

9. Siddiqui M. R., Sajid M. S., Khatri K., Cheek E., Baig M. K. Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial. World Journal of Surgery. 2010 Dec; 34 (12): 2883–2901.

10. Solaini L., Bocchino A., Avanzolini A., Annunziata D., Cavaliere D., Ercolani G. Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis. International Journal of Colorectal Disease. 2022 Jul; 37 (7): 1497–1507.

11. Barbash G. I., Glied S. A. New technology and health care costs--the case of robot-assisted surgery. New England Journal of Medicine. 2010 Aug 19; 363 (8): 701–704.

12. Sassun R., Sileo A., Ng J. C., Mari G., Behm K. T., Shawki S. F., Larson D. W. Diverticular disease complicated by colovesical and colovaginal fistulas: not so complex robotically. Surgical Endoscopy. 2025 Jun; 39 (6): 3941–3946.

13. Martinolich J., Croasdale D. R., Bhakta A. S., Ata A., Chismark A. D., Valerian B. T., Canete J. J., Lee E. C. Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution. Journal of Gastrointestinal Surgery. 2019 May; 23 (5): 1015–1021.

14. Trejo-Avila M., Vergara-Fernández O. Open versus laparoscopic surgery for the treatment of diverticular colovesical fistulas: A systematic review and meta-analysis. ANZ Journal of Surgery. 2021 Sep; 91 (9): E570–E577.

15. Raskin E.R., Keller D.S., Gorrepati M.L. et al. Propensity-matched analysis of sigmoidectomies for diverticular disease. Journal of the Society of Laparoendoscopic Surgeons. 2019 Jan-Mar; 23 (1): e2018.00073.

16. Al-Temimi M. H., Chandrasekaran B., Agapian J., Peters W. R. Jr., Wells K. O. Robotic versus laparoscopic elective colectomy for left side diverticulitis: a propensity score-matched analysis of the NSQIP database. International Journal of Colorectal Disease. 2019 Aug; 34 (8): 1385–1392.

17. Bastawrous A. L., Landmann R. G., Liu Y., Liu E., Cleary R. K. Incidence, associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease. Surgical Endoscopy. 2020 Feb; 34 (2): 598–609.

18. Larkins K., Mohan H., Apte S. S., Chen V., Rajkomar A., Larach J. T., Smart P., Heriot A., Warrier S. A systematic review and meta-analysis of robotic resections for diverticular disease. Colorectal Disease. 2022 Oct; 24 (10): 1105–1116.

19. Kulaylat A. S., Mirkin K. A., Puleo F. J., Hollenbeak C. S., Messaris E. Robotic versus standard laparoscopic elective colectomy: where are the benefits? Journal of Surgical Research. 2018 Apr; 224: 72–78.

20. Eltyeb H. A., Mohamedahmed A. Y. Y., Mills G. A., Khan J. Left colectomy for diverticular disease: systematic review and meta-analysis comparing robotic and laparoscopic resections. Techniques in Coloproctology. 2025 May 25; 29 (1): 121.

21. Beltzer C., Knoerzer L., Bachmann R., Axt S., Dippel H., Schmidt R. Robotic Versus Laparoscopic Sigmoid Resection for Diverticular Disease: A Single-Center Experience of 106 Cases. Journal of Laparoendoscopic and Advansed Surgical Techiques A. 2019 Nov; 29 (11): 1451–1455.

22. Presl J., Ehgartner M., Schabl L., Singhartinger F., Gantschnigg A., Wallner E., Jäger T., Emmanuel K., Kessler H., Koch O. O. Robotic surgery versus conventional laparoscopy in sigmoid colectomy for diverticular disease-a comparison of operative trauma and cost-effectiveness: retrospective, single-center analysis. Langenbeck's Archives of Surgery. 2024 Jun 27; 409 (1): 200.