V73 - Robotic sigmoidectomy for diverticulitis complicated with intramesenteric abscess

Purpose/Background: Complicated diverticulitis with associated abscess formation often results in dense inflammatory changes that make minimally invasive resection technically challenging. Robotic-assisted surgery offers enhanced dexterity and three-dimensional visualization, which are advantageous when operating in inflamed or scarred planes. We present a case of a 68-year-old woman with a history of diverticulosis who presented with acute sigmoid diverticulitis complicated by a 5 × 5 cm intramesenteric abscess, successfully managed with a robotic sigmoidectomy after initial nonoperative therapy.

Methods/Interventions: After medical optimization and interval resolution of infection with antibiotics and IR drainage, follow-up imaging demonstrated a residual air-filled cavity in the sigmoid mesentery. The operation was performed using the da Vinci Xi robotic platform. A medial-to-lateral approach was initiated beneath the inferior mesenteric vein to define the proper avascular plane. The inferior mesenteric artery was isolated at its bifurcation, controlled with hemo-locks, and divided using the robotic vessel sealer. The inferior mesenteric vein was divided proximally to achieve adequate length for a tension-free anastomosis. The splenic flexure was fully mobilized, and the lateral attachments of the descending and sigmoid colon were released. The inflamed sigmoid segment was resected without breaching the intramesenteric abscess cavity. A small suprapubic incision was used for specimen extraction, and a double-stapled end-to-end colorectal anastomosis was fashioned with intraoperative leak testing and colonoscopic inspection.

Results/Outcomes: The procedure was completed entirely robotically without conversion or diversion. The intracorporeal dissection allowed precise identification of critical structures, including the ureter and adjacent adnexa, despite dense inflammatory adhesions. A tension-free, well-vascularized anastomosis was achieved with no intraoperative complications or bleeding. The patient recovered uneventfully, experienced minimal postoperative pain, and was discharged home after a short hospitalization. At follow-up, the patient remained asymptomatic with no evidence of anastomotic leak or hernia at the extraction site.

Conclusion/Discussion: Robotic sigmoidectomy is safe and feasible for complicated diverticulitis with contained intramesenteric abscess. The robotic platform provides superior visualization and instrument dexterity, facilitating meticulous dissection in inflamed planes while preserving adjacent structures. Intracorporeal resection and reconstruction optimize exposure, reduce bowel manipulation, and may lower postoperative morbidity, contributing to faster recovery and improved outcomes compared to conventional approaches.