Surgical outcomes in diverticular disease: a comparative analysis of robotic and laparoscopic sigmoidectomy

Minimally invasive surgery (MIS) has become the standard approach for the treatment of diverticular disease; however, the optimal technique remains a topic of ongoing investigation. This study compares laparoscopic (LS) and robotic (RS) sigmoidectomy in elective and semi-urgent settings. All consecutive patients who underwent elective or semi-urgent MIS for diverticular disease at San Paolo Hospital, Milan (June 2019-December 2024) were included. Semi-urgent procedures were defined as surgeries performed during the same admission, after stabilization of an acute episode or failure of conservative treatment. Surgical complexity was defined by the presence of at least one of four key intraoperative parameters: pseudotumor, fistula, abscess, or active disease. Primary outcomes included intraoperative and short-term postoperative results; secondary outcomes examined surgical complexity to identify potential challenges. One hundred patients (RS n = 51; LS n = 49) were included. Baseline characteristics were comparable, except for a significantly higher rate of previous abdominal surgery in the RS group (p = 0.002). Operative time was longer in RS (p < 0.001), but conversion to open surgery occurred in 12.2% of LS cases and none in RS (p = 0.012). RS was associated with faster bowel function recovery (p < 0.001), shorter hospital stay (p = 0.04), and fewer incisional hernias at follow-up (p = 0.01). Major complications (Clavien–Dindo ≥ III) were less frequent in RS in high-complexity subgroup (p = 0.03). Robotic sigmoidectomy improved short-term recovery and reduced conversion rates compared with laparoscopy, despite longer operative times. These findings support its safe and effective application in unselected patients with diverticular disease and justify further prospective evaluation.