The Reading Hospital and Medical Center, Sixth Avenue and Spruce Street, P.O. Box 16052, West Reading, PA 19611, USA.
Obes Surg. 2013 Apr;23(4):467-73. doi: 10.1007/s11695-012-0848-0.
Roux-en-Y gastric bypass is an effective treatment for severe obesity and obesity-related comorbidities. Presently, gastric bypass is performed most often laparoscopically, although a robotic-assisted procedure is the preferred approach for an increasing number of bariatric surgeons.
This retrospective study compared the results of 100 Roux-en-Y gastric bypass operations using the da Vinci robot and 100 laparoscopic Roux-en-Y gastric bypasses performed laparoscopically. Short-term outcomes were determined by evaluating mortality, length of stay, length of operation, return to the operating room within 90 days of operation, conversions to open procedure, leaks, strictures, transfusions, and hospital readmissions.
There was no mortality, pulmonary embolus, or conversion to open procedure in either group. Both the laparoscopic and robotic operative times decreased progressively, although the robotic operation time was longer (mean, 144 versus 87 min, P < 0.001). The length of stay was shorter for the robotic-assisted group (37 versus 52 h, P < 0.001), and 60% of these patients were discharged after one night's stay (P < 0.001). There were fewer transfusions (P = 0.005) and readmissions (P = .560) in the robotic group. The stricture rate was higher in the first 50 robotic procedures (17 mm gastrotomy) but resolved in the second 50 procedures (21 mm gastrotomy). There was no difference in the rate of leak and return to the operating room between groups (both P > 0.05).
These results indicate that Roux-en-Y gastric bypass can be performed safely with robotic assistance, even during the first 100 cases.
Roux-en-Y 胃旁路手术是治疗严重肥胖症和肥胖相关合并症的有效方法。目前，胃旁路手术最常通过腹腔镜进行，尽管越来越多的减重外科医生更喜欢使用机器人辅助手术。
本回顾性研究比较了使用达芬奇机器人进行的 100 例 Roux-en-Y 胃旁路手术和 100 例通过腹腔镜进行的腹腔镜 Roux-en-Y 胃旁路手术的结果。通过评估死亡率、住院时间、手术时间、手术后 90 天内返回手术室、转为开放手术、漏诊、狭窄、输血和住院再入院等情况来确定短期结果。
两组均无死亡、肺栓塞或转为开放手术。腹腔镜和机器人手术时间均逐渐缩短，但机器人手术时间更长（平均 144 分钟对 87 分钟，P < 0.001）。机器人辅助组的住院时间更短（37 小时对 52 小时，P < 0.001），其中 60%的患者在住院一晚后出院（P < 0.001）。机器人组的输血（P = 0.005）和再入院（P =.560）次数更少。在前 50 例机器人手术中（17 毫米胃造口术），狭窄发生率较高，但在随后的 50 例手术中（21 毫米胃造口术）得到解决。两组之间的漏诊率和返回手术室率无差异（均 P > 0.05）。
这些结果表明，即使在最初的 100 例手术中，机器人辅助也可以安全地进行 Roux-en-Y 胃旁路手术。
