Safety of robotic surgical management of non-elective colectomies for diverticulitis compared to laparoscopic surgery.
Acute care surgery
Colorectal surgery
Diverticulitis
Minimally invasive surgery
Non-elective surgery
Robotic surgery
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
13
06
2022
accepted:
11
08
2022
medline:
7
4
2023
pubmed:
2
9
2022
entrez:
1
9
2022
Statut:
ppublish
Résumé
Non-elective minimally invasive surgery (MIS) remains controversial, with minimal focus on robotics. This study aims to evaluate the short-term outcomes for non-elective robotic colectomies for diverticulitis. All colectomies for diverticulitis in ACS-NSQIP between 2012 and 2019 were identified by CPT and diagnosis codes. Open and elective cases were excluded. Patients with disseminated cancer, ascites, and ventilator-dependence were excluded. Procedures were grouped by approach (laparoscopic and robotic). Demographics, operative variables, and postoperative outcomes were compared between groups. Covariates with p < .1 were entered into multivariable logistic regression models for 30 day mortality, postoperative septic shock and reoperation. 6880 colectomies were evaluated (Laparoscopic = 6583, Robotic = 297). The laparoscopic group included more preoperative sepsis (31.6% vs. 10.8%), emergency cases (32.3% vs. 6.7%), and grade 3/4 wound classifications (53.3% vs. 42.8%). There was no difference in mortality, anastomotic leak, SSI, reoperation, readmission, or length of stay. The laparoscopic group had more postoperative sepsis (p = 0.001) and the robotic group showed increased bleeding (p = 0.011). In a multivariate regression model, increased age (OR = 1.083, p < 0.001), COPD (OR = 2.667, p = 0.007), dependent functional status (OR = 2.657, p = 0.021), dialysis (OR = 4.074, p = 0.016), preoperative transfusions (OR = 3.182, p = 0.019), emergency status (OR = 2.241, p = 0.010), higher ASA classification (OR = 3.170, p = 0.035), abnormal WBC (OR = 1.883, p = 0.046) were independent predictors for mortality. When controlling for confounders, robotic approach was not statistically significantly associated with septic shock or reoperation. When controlling for confounders, robotic approach was not a predictor for mortality, reoperation or septic shock. Robotic surgery is a feasible option for the acute management of diverticulitis.
Identifiants
pubmed: 36048320
doi: 10.1007/s11701-022-01452-3
pii: 10.1007/s11701-022-01452-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
587-595Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
Références
Hawkins AT, Wise PE, Chan T (2020) Diverticulitis: an update from the age old paradigm. Curr Probl Surg 57(10):100862. https://doi.org/10.1016/j.cpsurg.2020.100862
doi: 10.1016/j.cpsurg.2020.100862
pubmed: 33077029
pmcid: 7575828
Lanas A, Abad-Baroja D, Lanas-Gimeno A (2018) Progress and challenges in the management of diverticular disease: which treatment? Therap Adv Gastroenterol. https://doi.org/10.1177/1756284818789055
doi: 10.1177/1756284818789055
pubmed: 30046356
pmcid: 6056793
Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg. https://doi.org/10.1097/SLA.0b013e3181952888
doi: 10.1097/SLA.0b013e3181952888
pubmed: 19212172
Kozak LJ, DeFrances CJ, Hall MJ (2006) National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13(162):1–209
Sartelli M, Weber DG, Kluger Y (2020) (2020) 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 15:32. https://doi.org/10.1186/s13017-020-00313-4
doi: 10.1186/s13017-020-00313-4
pubmed: 32381121
pmcid: 7206757
Wieghard N, Geltzeiler CB, Tsikitis VL (2015) (2015) Trends in the surgical management of diverticulitis. Ann Gastroenterol 28(1):25–30
pubmed: 25608492
pmcid: 4290000
Wexner, Steven D., and Mark A. Talamini. (2019) EAES/SAGES consensus conference on acute diverticulitis: A paradigm shift in the management of acute diverticulitis. Surgical endoscopy. Available at: 2724–2725, http://proxygw.wrlc.org/login?url=https://www.proquest.com/scholarly-journals/eaes-sages-consensus-conference-on-acute/docview/2267590905/se-2?accountid=11243 , Accessed February 17, 2022.
van de Wall BJM, Stam MAW, Draaisma WA, Stellato R, Bemelman WA, Boermeester MA, Broeders IAMJ, Belgers EJ, Toorenvliet BR, Prins HA, Consten ECJ (2016) DIRECT trial collaborators. Surgery versus conservative management for recurrent and ongoing left-sided diverticulitis (DIRECT trial): an open-label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol. https://doi.org/10.1016/S2468-1253(16)30109-1 (Epub 2016 Oct 19)
doi: 10.1016/S2468-1253(16)30109-1
pubmed: 28404008
Masoomi H, Buchberg B, Nguyen B, Tung V, Stamos MJ, Mills S (2011) Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis. World J Surg. https://doi.org/10.1007/s00268-011-1117-4
doi: 10.1007/s00268-011-1117-4
pubmed: 21732208
Turley RS, Mantyh CR, Migaly J (2013) Minimally invasive surgery for diverticulitis. Tech Coloproctol. https://doi.org/10.1007/s10151-012-0940-4
doi: 10.1007/s10151-012-0940-4
pubmed: 24085640
Dharmarajan S, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum. https://doi.org/10.1007/DCR.0b013e31820ef759
doi: 10.1007/DCR.0b013e31820ef759
pubmed: 21552049
Sallinen VJMD, Ph D, Mentula PJMD, Ph D, Leppäniemi AKMD, Ph D (2014) Nonoperative management of perforated diverticulitis with extraluminal air is safe and effective in selected patients. Dis Colon Rectum. https://doi.org/10.1097/DCR.0000000000000083
doi: 10.1097/DCR.0000000000000083
pubmed: 24901689
You H, Sweeny A, Cooper ML, Von Papen M, Innes J (2019) The management of diverticulitis: a review of the guidelines. Med J Aust. https://doi.org/10.5694/mja2.50276
doi: 10.5694/mja2.50276
pubmed: 31352692
Nascimbeni R, Amato A, Cirocchi R (2021) Management of perforated diverticulitis with generalized peritonitis. Tech Coloproctol, A multidisciplinary review and position paper. https://doi.org/10.1007/s10151-020-02346-y
doi: 10.1007/s10151-020-02346-y
Schultz JK, Azhar N, Binda GA (2020) European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis. https://doi.org/10.1111/codi.15140
doi: 10.1111/codi.15140
pubmed: 32638537
Binda GA, Karas JR, Serventi A, Sokmen S, Amato A, Hydo L, Bergamaschi R (2012) Study Group on Diverticulitis Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial. Colorectal Dis. https://doi.org/10.1111/j.1463-1318.2012.03117.x
doi: 10.1111/j.1463-1318.2012.03117.x
pubmed: 22672447
Lambrichts DPV, Vennix S, Musters GD, Mulder IM, Swank HA, Hoofwijk AGM, Belgers EHJ, Stockmann HBAC, Eijsbouts QAJ, Gerhards MF, van Wagensveld BA, van Geloven AAW, Crolla RMPH, Nienhuijs SW, Govaert MJPM, di Saverio S, D’Hoore AJL, Consten ECJ, van Grevenstein WMU, Pierik REGJM, Kruyt PM, van der Hoeven JAB, Steup WH, Catena F, Konsten JLM, Vermeulen J, van Dieren S, Bemelman WA, Lange JF (2019) LADIES trial collaborators Hartmann’s procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial. Lancet Gastroenterol Hepatol. 4(8):599–610
doi: 10.1016/S2468-1253(19)30174-8
pubmed: 31178342
Angenete E, Thornell A, Burcharth J, Pommergaard HC, Skullman S, Bisgaard T, Jess P, Läckberg Z, Matthiessen P, Heath J, Rosenberg J, Haglind E (2016) Laparoscopic lavage is feasible and safe for the treatment of perforated diverticulitis with purulent peritonitis: the first results from the randomized controlled trial DILALA. Ann Surg. https://doi.org/10.1097/SLA.0000000000001061
doi: 10.1097/SLA.0000000000001061
pubmed: 25906414
Schultz JK, Yaqub S, Wallon C, Blecic L, Forsmo HM, Folkesson J, Buchwald P, Körner H, Dahl FA, Øresland T (2015) SCANDIV Study Group. The SCANDIV Randomized Clinical Trial. JAMA, Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis. https://doi.org/10.1001/jama.2015.12076
doi: 10.1001/jama.2015.12076
Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH, van Geloven AA, Gerhards MF, Govaert MJ, van Grevenstein WM, Hoofwijk AG, Kruyt PM, Nienhuijs SW, Boermeester MA, Vermeulen J, van Dieren S, Lange JF, Bemelman WA (2019) Ladies trial colloborators Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet 386(10000):1269–1277
doi: 10.1016/S0140-6736(15)61168-0
Constantinides VA, Heriot A, Remzi F, Darzi A, Senapati A, Fazio VW, Tekkis pp (2007) Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann’s procedures. Ann Surg. https://doi.org/10.1097/01.sla.0000225357.82218.ce
doi: 10.1097/01.sla.0000225357.82218.ce
pubmed: 17197971
pmcid: 1867925
Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK (2009) Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. Am J Surg. https://doi.org/10.1016/j.amjsurg
doi: 10.1016/j.amjsurg
Gaertner WB, Kwaan MR, Madoff RD, Willis D, Belzer GE, Rothenberger DA, Melton GB (2013) The evolving role of laparoscopy in colonic diverticular disease: a systematic review. World J Surg 37(3):629–638
doi: 10.1007/s00268-012-1872-x
pubmed: 23192170
Raskin ER, Keller DS, Gorrepati ML, Akiel-Fu S, Mehendale S, Cleary RK (2019) Propensity-matched analysis of sigmoidectomies for diverticular disease. JSLS. https://doi.org/10.4293/JSLS.2018.00073
doi: 10.4293/JSLS.2018.00073
pubmed: 30675092
pmcid: 6328361
Bilgin IA, Bas M, Benlice C et al (2020) Totally laparoscopic and totally robotic surgery in patients with left-sided colonic diverticulitis. Int J Med Robot. https://doi.org/10.1002/rcs.2068
doi: 10.1002/rcs.2068
pubmed: 33289228
Giuliani G, Guerra F, Coletta D (2021) Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis [published correction appears in Int J Colorectal Dis]. Int J Colorectal Dis. https://doi.org/10.1007/s00384-021-04038-x
doi: 10.1007/s00384-021-04038-x
pubmed: 34716474
Al-Temimi MH, Chandrasekaran B, Agapian J, Peters WR Jr, Wells KO (2019) Robotic versus laparoscopic elective colectomy for left side diverticulitis: a propensity score-matched analysis of the NSQIP database. Int J Colorectal Dis. https://doi.org/10.1007/s00384-019-03334-x
doi: 10.1007/s00384-019-03334-x
pubmed: 31230107
Bastawrous AL, Landmann RG, Liu Y, Liu E, Cleary RK (2020) Incidence associated risk factors, and impact of conversion to laparotomy in elective minimally invasive sigmoidectomy for diverticular disease. Surg Endosc. https://doi.org/10.1007/s00464-019-06804-z
doi: 10.1007/s00464-019-06804-z
pubmed: 31062152
Moghadamyeghaneh Z, Masoomi H, Mills SD (2014) Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS. https://doi.org/10.4293/JSLS.2014.00230
doi: 10.4293/JSLS.2014.00230
pubmed: 25587213
pmcid: 4283100
Masoomi H, Moghadamyeghaneh Z, Mills S, Carmichael JC, Pigazzi A, Stamos MJ (2015) Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome? World J Surg 39(5):1240–1247. https://doi.org/10.1007/s00268-015-2958-z
doi: 10.1007/s00268-015-2958-z
pubmed: 25631940
Cassini D, Depalma N, Grieco M, Cirocchi R, Manoochehri F, Baldazzi G (2019) (2014) Robotic pelvic dissection as surgical treatment of complicated diverticulitis in elective settings: a comparative study with fully laparoscopic procedure. Surg Endosc 33(8):2583–2590. https://doi.org/10.1007/s00464-018-6553-x
doi: 10.1007/s00464-018-6553-x
pubmed: 30406387
Maciel V, Lujan HJ, Plasencia G (2014) (2014) Diverticular disease complicated with colovesical fistula: laparoscopic versus robotic management. Int Surg 99(3):203–210. https://doi.org/10.9738/INTSURG-D-13-00201.1
doi: 10.9738/INTSURG-D-13-00201.1
pubmed: 24833140
pmcid: 4027901
American Society of Colon and Rectal Surgeons (2020) Treatment of Left-Sided Colonic Diverticulitis. Guideline Central, Accessed Jan, p 29
Valizadeh N, Suradkar K, Kiran RP (2018) Specific factors predict the risk for urgent and emergent colectomy in patients undergoing surgery for diverticulitis. Am Surg 84(11):1781–1786
doi: 10.1177/000313481808401135
pubmed: 30747633
Anaya DA, Flum DR (2005) Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 140(7):681–685. https://doi.org/10.1001/archsurg.140.7.681
doi: 10.1001/archsurg.140.7.681
pubmed: 16027334
Lu J, S., Parfitt, C., Stefan, S., & Khan, J. S. (2021) Emergency robotic colorectal surgery—the new frontier; a case series study. Eur J Surg Oncol 47(1):e26–e26. https://doi.org/10.1016/j.ejso.2020.11.118
doi: 10.1016/j.ejso.2020.11.118
de Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D’Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F (2022) Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg. 17(1):4. https://doi.org/10.1186/s13017-022-00410-6
doi: 10.1186/s13017-022-00410-6
Anderson M, Lynn P, Aydinli HH, Schwartzberg D, Bernstein M, Grucela A (2020) Early experience with urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable perioperative outcomes to laparoscopic surgery. J Robot Surg 14(2):249–253. https://doi.org/10.1007/s11701-019-00968-5 (Epub 2019 May 10)
doi: 10.1007/s11701-019-00968-5
pubmed: 31076952
Lin C-S, Chen C-Y, Yeh C-C, Chung C-L, Chen T-L, Liao C-C (2019) Defining risk of general surgery in patients with chronic obstructive pulmonary diseases. QJM Intern J Med. https://doi.org/10.1093/qjmed/hcy240
doi: 10.1093/qjmed/hcy240
Kim TH, Lee JS, Lee SW, Oh YM (2016) Pulmonary complications after abdominal surgery in patients with mild-to-moderate chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. https://doi.org/10.2147/COPD.S119372
doi: 10.2147/COPD.S119372
pubmed: 28031708
pmcid: 5182037
Muse A, Wusterbarth E, Thompson S, Thompson E, Saeed S, Deeyor S, Lee J, Krall E, Hamidi M, Nfonsam V (2021) The role of preoperative anemia in patients undergoing colectomy for diverticular disease: does surgical urgency matter? Int J Colorectal Dis 36(11):2463–2470. https://doi.org/10.1007/s00384-021-03954-2 (Epub 2021 May 20)
doi: 10.1007/s00384-021-03954-2
pubmed: 34014356
Tam FS, Klein JM, Chung JP, Lee R, Duncan A, Alfonso EA (2016) Be aware of blood transfusion in colectomy for diverticular disease. Clin Surg 1:1027
Rawlings AL, Woodland JH, Vegunta RK (2007) Robotic versus laparoscopic colectomy. Surg Endosc. https://doi.org/10.1007/s00464-007-9231-y
doi: 10.1007/s00464-007-9231-y
pubmed: 17353988
TylerJoshua A, FoxJustin P, Desai Perry MMBW, Glasgow SC (2013) Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rec. https://doi.org/10.1097/DCR.0b013e31827085ec
doi: 10.1097/DCR.0b013e31827085ec
Ogilvie JW Jr, Saunders RN, Parker J, Luchtefeld MA (2019) Sigmoidectomy for diverticulitis-A propensity-matched comparison of minimally invasive approaches. J Surg Res 243:434–439. https://doi.org/10.1016/j.jss.2019.06.018 (Epub 2019 Jul 3)
doi: 10.1016/j.jss.2019.06.018
pubmed: 31279270
Vasudevan V, Reusche R, Wallace H (2016) (2016) Clinical outcomes and cost–benefit analysis comparing laparoscopic and robotic colorectal surgeries. Surg Endosc 30:5490–5493. https://doi.org/10.1007/s00464-016-4910-1
doi: 10.1007/s00464-016-4910-1
pubmed: 27126626
Formisano G, Giuliani G, Salaj A, Salvischiani L, Ferraro L, Luca M, Bianchi pp (2021) Robotic elective colectomy for diverticular disease: short-term outcomes of 80 patients. Int J Med Robot. https://doi.org/10.1002/rcs.2204 (Epub 2020 Dec 8)
doi: 10.1002/rcs.2204
pubmed: 33185931
Sudan R, Desai SS (2012) Emergency and weekend robotic surgery are feasible. J Robot Surg 6(3):263–266. https://doi.org/10.1007/s11701-011-0289-0 (Epub 2011 Jun 30)
doi: 10.1007/s11701-011-0289-0
pubmed: 27638285
Judd JP, Siddiqui NY, Barnett JC, Visco AG, Havrilesky LJ, Wu JM (2010) Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2010.03.011
doi: 10.1016/j.jmig.2010.03.011
pubmed: 20621010
American College of Surgeons. Participant Use Request Form. ACS-NSQIP Participant Use Resources. Accessed at https://www.facs.org/quality-programs/acs-nsqip/participant-use/puf-form , Accessed on January 3, 2022.