Buchs Nicolas C, Morel Philippe, Azagury Dan E, Jung Minoa, Chassot Gilles, Huber Olivier, Hagen Monika E, Pugin François
Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland,
Obes Surg. 2014 Dec;24(12):2031-9. doi: 10.1007/s11695-014-1335-6.
Laparoscopic Roux-en-Y gastric bypass (RYGB) has become the procedure of choice for the treatment of morbid obesity. Recently, several reports have shown the potential advantages of the robotic approach, notably by reducing complications. The aim of this study is to report our long-term experience with robotic Roux-en-Y gastric bypass (RYGB) and to compare outcomes with the laparoscopic approach.
From January 2003 to September 2013, 777 consecutive minimally invasive RYGB have been performed in our institution: 389 laparoscopically (50.1 %) and 388 robotically (49.9 %). During the study period, all the data regarding these consecutive RYGB has been prospectively collected in a dedicated database.
While longer in duration compared to laparoscopy (+30 min; p=0.0001), the robotic approach had a lower conversion rate (0.8 vs. 4.9 %; p=0.0007), and less complications (11.6 % vs. 16.7 %; p=0.05), in particular, less gastrointestinal leaks (0.3 vs. 3.6 %; p=0.0009). There were also less early reoperations (1 vs. 3.3 %; p=0.05) and a shorter hospital stay in the robotic group (6.2 vs. 10.4 days; p=0.0001). There were no statistical differences between the early and the current robotic experience, except in operative time and hospital stay, which were shorter for the last 100 cases. Finally, the BMI loss was significantly higher in the laparoscopic group starting at the first post-operative year.
Robotic RYGB is not only safe and feasible, but also a valid option in comparison to laparoscopy. At the cost of a longer operative time, we observed better short-term outcomes with the robotic approach.
腹腔镜Roux-en-Y胃旁路术（RYGB）已成为治疗病态肥胖症的首选术式。最近，一些报告显示了机器人辅助手术方法的潜在优势，特别是在减少并发症方面。本研究的目的是报告我们在机器人辅助Roux-en-Y胃旁路术（RYGB）方面的长期经验，并将其结果与腹腔镜手术方法进行比较。
2003年1月至2013年9月，我们机构连续进行了777例微创RYGB手术：389例为腹腔镜手术（50.1%），388例为机器人辅助手术（49.9%）。在研究期间，所有关于这些连续RYGB手术的数据都被前瞻性地收集到一个专用数据库中。
与腹腔镜手术相比，机器人辅助手术时间更长（+30分钟；p=0.0001），但转换率更低（0.8%对4.9%；p=0.0007），并发症更少（11.6%对16.7%；p=0.05），尤其是胃肠道漏更少（0.3%对3.6%；p=0.0009）。机器人辅助组早期再次手术也更少（1%对3.3%；p=0.05），住院时间更短（6.2天对10.4天；p=0.0001）。早期和当前机器人辅助手术经验之间没有统计学差异，但手术时间和住院时间除外，最近100例患者的手术时间和住院时间更短。最后，从术后第一年开始，腹腔镜组的体重指数下降明显更高。
机器人辅助RYGB不仅安全可行，而且与腹腔镜手术相比是一种有效的选择。以更长的手术时间为代价，我们观察到机器人辅助手术方法有更好的短期结果。
