Robotic-assisted Hartmann’s reversal for complicated diverticulitis: Operative technique and key steps

Hartmann’s reversal remains one of the most technically challenging procedures in colorectal surgery, with low reversal rates and substantial morbidity driven by dense adhesions, distorted pelvic anatomy, and difficulty identifying and mobilizing the rectal stump. Although minimally invasive surgical (MIS) approaches have demonstrated lower postoperative morbidity, fewer anastomotic leaks, and shorter hospitalization compared to open surgery, robotic-assisted Hartmann’s reversal remains technically demanding and requires careful operative planning and standardized technique. We present the case of a 54-year-old woman with a history of hysterectomy and recurrent complicated diverticulitis associated with pericolic abscess formation who underwent an emergent Hartmann’s procedure after failure of conservative medical management for a recurrent diverticular abscess not amenable to percutaneous drainage. Following postoperative recovery, she returned nine months later for restoration of intestinal continuity, and a robotic approach was selected given the anticipated technical complexity of reversal. This video demonstrates our standardized robotic technique for Hartmann’s reversal with emphasis on trocar placement, adhesiolysis, pelvic dissection, rectal stump identification, and restoration of intestinal continuity. Key operative steps are presented sequentially to facilitate reproducibility and improve understanding of the technical nuances associated with this operation. MIS approaches may improve recovery by reducing surgical trauma, shortening hospitalization, and supporting Enhanced Recovery After Surgery (ERAS) pathways focused on early mobilization, multimodal analgesia, and accelerated return of bowel function.