Robotic Hartmann’s Reversal

The reversal of Hartmann’s procedure was first described by Boyden et al., who reported on the reversal of six colostomies, while the first laparoscopic approach to Hartmann’s reversal (HR) was described by Anderson et al. The minimally invasive approach seemed to be superior to open surgery, but the challenge of laparoscopy remained adhesiolysis, which caused a variable rate of conversions ranging from 0% to 50%. In this scenario, the introduction of the robotic approach seemed to overcome some of the technical difficulties of laparoscopy. The stable 3D vision camera and the EndoWrist technology decrease the technical challenges of adhesiolysis, reducing the need for conversion. Literature data on the robotic approach to HR are scarce and anecdotal. The only cohort study on the application of robotic surgery to HR was performed by Giuliani et al., who reported on the results of the robotic approach in 24 patients, recording no major complications. This chapter explains the technical details of robotic HR and reviews the current literature on the topic.