Mohr Catherine J, Nadzam Geoffrey S, Curet Myriam J
Department of Surgery, Stanford School of Medicine, Stanford Hospital, 300 Pasteur Drive, Stanford, CA 94305, USA.
Arch Surg. 2005 Aug;140(8):779-86. doi: 10.1001/archsurg.140.8.779.
We hypothesized that we could develop a safe and effective technique for performing a totally robotic laparoscopic Roux-en-Y gastric bypass procedure using the da Vinci surgical system. We anticipated that the learning curve for this totally robotic procedure could be shorter than the learning curve for standard laparoscopic bariatric surgery.
Retrospective case comparison study.
Academic tertiary care center.
Consecutive samples of patients who met National Institutes of Health (NIH) criteria for morbid obesity and who completed the Stanford Bariatric Surgery Program evaluation process.
A port placement and robot positioning scheme was developed so that the entire case could be performed robotically. The first 10 patients who underwent a totally robotic laparoscopic Roux-en-Y gastric bypass were compared with a retrospective sample of 10 patients who had undergone laparoscopic Roux-en-Y gastric bypass surgery.
Patient age, gender, body mass index (BMI), numbers of NIH-defined comorbidities, operative time, length of stay, and complications.
No significant differences existed between the 2 patient series with regard to age, gender, or BMI. The median surgical times were significantly lower for the robotic procedures (169 vs 208 minutes; P = .03), as was the ratio of procedure time to BMI (3.8 vs 5.0 minutes per BMI for the laparoscopic cases; P = .04).
This study details the first report, to our knowledge, of a totally robotic laparoscopic Roux-en-Y gastric bypass and demonstrates the feasibility, safety, and potential superiority of such a procedure. In addition, the learning curve may be significantly shorter with the robotic procedure. Further experience is needed to understand the long-term advantages and disadvantages of the totally robotic approach.
我们假设能够利用达芬奇手术系统开发出一种安全有效的技术来实施完全机器人腹腔镜Roux-en-Y胃旁路手术。我们预计这种完全机器人手术的学习曲线可能比标准腹腔镜减肥手术的学习曲线更短。
回顾性病例对照研究。
学术性三级医疗中心。
符合美国国立卫生研究院（NIH）病态肥胖标准且完成斯坦福减肥手术项目评估流程的连续患者样本。
制定了端口放置和机器人定位方案，以便整个手术能够通过机器人完成。将首批10例行完全机器人腹腔镜Roux-en-Y胃旁路手术的患者与10例行腹腔镜Roux-en-Y胃旁路手术的回顾性样本患者进行比较。
患者年龄、性别、体重指数（BMI）、NIH定义的合并症数量、手术时间、住院时间和并发症。
两组患者在年龄、性别或BMI方面无显著差异。机器人手术的中位手术时间显著更短（169分钟对208分钟；P = 0.03），手术时间与BMI的比值也是如此（腹腔镜手术病例为每BMI 5.0分钟对3.8分钟；P = 0.04）。
据我们所知，本研究详细报道了首例完全机器人腹腔镜Roux-en-Y胃旁路手术，并证明了该手术的可行性、安全性和潜在优势。此外。机器人手术的学习曲线可能显著更短。需要更多经验来了解完全机器人手术方法的长期优缺点。
