Endoluminal and Emerging Robotic Platforms for Diverticulitis

Abstract The management of diverticulitis has evolved substantially over the past two decades, paralleling major advances in minimally invasive surgery. While laparoscopic colectomy was shown to be safe and effective compared with open surgery for uncomplicated disease with lower complication rates, faster return of bowel function, and shorter hospital stays, its application to complicated or recurrent diverticulitis was limited by difficult anatomy, technical constraints, and surgeon comfort. The advent of robotic surgery and robotic technology has transformed the clinical landscape and promoted the adoption of minimally invasive techniques in colorectal surgery by offering superior visualization, enhanced dexterity with wristed instrumentation, and improved ergonomics. These capabilities are advantageous in deep pelvic dissections and other scenarios where conventional laparoscopy is more challenging. The robotic approach is associated with reduced intraoperative blood loss, fewer conversions to open surgery, and faster functional recovery. Technological innovation continues to accelerate with the expansion of robotic platforms beyond the da Vinci model, including the single-port robot, the miniaturized MIRA system, and the new multi-arm modular Hugo and Versius systems. These emerging technologies incorporate features, such as flexible architectures, augmented visualization, haptic feedback, and integrated artificial intelligence to improve operative precision, communication, and workflow. Market expansion and diversification—driven by new manufacturers and expiring patents—has spurred competition that will hopefully reduce costs and broaden access. Early clinical experiences suggest that these platforms are safe and feasible in the management of diverticulitis. Despite rapid progress, controversy remains regarding the definitive superiority of robotics over laparoscopy. Current evidence supports a tailored and patient-centered approach that considers disease complexity, medical comorbidities, surgeon experience, and institutional resources. As the field advances and more randomized trials are performed, robotic technology is poised to further refine the surgical management of diverticulitis and contribute to improved patient safety, functional recovery, clinical outcomes, and long-term quality of life.