Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabriel-Perret-Gentil 4, 1211, Geneva, Switzerland.
Obes Surg. 2013 Mar;23(3):353-7. doi: 10.1007/s11695-012-0824-8.
Superobese patients (SO) (body mass index (BMI) ≥ 50 kg/m(2)) represent a real surgical challenge and the best management remains debatable. While the safety of a laparoscopic approach has been questioned for this population, robotics has been introduced in the armamentarium of the bariatric surgeon, yet its role remains poorly assessed, especially for a very high BMI. The study aim is thus to report our experience with robot-assisted Roux-en-Y gastric bypass (RYGB) for SO. From July 2006 to May 2012, 288 consecutive robot-assisted RYGB procedures have been performed at a single institution. All data were collected prospectively in a dedicated database. Among those patients, 41 were SO (14.2 %). All the peri- and postoperative parameters were compared to the morbidly obese (MO) group (BMI < 50). Data have been reviewed retrospectively. The SO group presented a higher ASA score and more male patients. The operative time was similar between both groups, yet there were more conversions in the SO group (two versus one for MO; p = 0.05). The morbidity and mortality rates were similar between both groups. The length of stay was longer for the SO population (7 vs. 6 days; p = 0.03). The percent BMI loss was similar at 1 year (34 vs. 34 %; p = 1), but the percent excess BMI loss was higher for the MO group (83 vs. 65 % for the SO group; p = 0.0007). Robot-assisted RYGB can be performed safely for SO, with complication rates and functional results at 1 year comparable to MO, yet this approach for SO has been associated with a slightly increased conversion rate and length of stay.
超肥胖患者（SO）（体重指数（BMI）≥50kg/m²）是一个真正的手术挑战，其最佳治疗方案仍存在争议。虽然腹腔镜方法在该人群中的安全性受到质疑，但机器人技术已被引入减重外科医生的武器库中，但它的作用仍未得到充分评估，尤其是对于非常高的 BMI。因此，本研究旨在报告我们使用机器人辅助 Roux-en-Y 胃旁路术（RYGB）治疗 SO 的经验。从 2006 年 7 月至 2012 年 5 月，在一家机构连续进行了 288 例机器人辅助 RYGB 手术。所有数据均在专用数据库中前瞻性收集。在这些患者中，41 例为 SO（14.2%）。所有围手术期参数均与病态肥胖（MO）组（BMI<50）进行比较。数据进行回顾性审查。SO 组的 ASA 评分较高，男性患者较多。两组的手术时间相似，但 SO 组的转化率更高（2 例与 MO 组的 1 例相比；p=0.05）。两组的发病率和死亡率相似。SO 组的住院时间较长（7 天与 6 天；p=0.03）。1 年时的 BMI 丢失百分比相似（34%与 34%；p=1），但 MO 组的 BMI 过量丢失百分比更高（83%比 SO 组的 65%；p=0.0007）。机器人辅助 RYGB 可安全用于 SO，1 年时的并发症发生率和功能结果与 MO 相似，但这种方法与 SO 相关的转化率和住院时间略长。
