Villamere James, Gebhart Alana, Vu Stephen, Nguyen Ninh T
Department of Surgery, University of California, Irvine Medical Center, 333 City Blvd. West, Suite 850, Orange, CA, 92868, USA,
Surg Endosc. 2015 Jul;29(7):1729-36. doi: 10.1007/s00464-014-3886-y. Epub 2014 Oct 16.
Robotic-assisted general and bariatric surgery is gaining popularity among surgeons. The aim of this study was to analyze the utilization and outcome of laparoscopic versus robotic-assisted laparoscopic techniques for common elective general and bariatric surgical procedures performed at Academic Medical Centers.
We analyzed data from University HealthSystem Consortium clinical database from October 2010 to February 2014 for all patients who underwent laparoscopic versus robotic techniques for eight common elective general and bariatric surgical procedures: gastric bypass, sleeve gastrectomy, gastric band, antireflux surgery, Heller myotomy (HM), cholecystectomy (LC), colectomy, rectal resection (RR). Utilization and outcome measures including demographics, in-hospital mortality, major complications, 30-day readmission, length of stay (LOS), and costs were compared between techniques.
96,694 laparoscopic and robotic procedures were analyzed. Utilization of the robotic approach was the highest for RR (21.4%), followed by HM (9.1%). There was no significant difference in in-hospital mortality or major complications between laparoscopic versus robotic techniques for all procedures. Only two procedures had improved outcome associated with the robotic approach: robotic HM and robotic LC had a shorter LOS compared to the laparoscopic approach (2.8 ± 3.6 vs. 2.3 ± 2.1; respectively, p < 0.05 for HM and 2.9 ± 2.4 vs. 2.3 ± 1.7; respectively, p < 0.05 for LC). Costs were significantly higher (21%) in the robotic group for all procedures. A subset analysis of patients with minor/moderate severity of illness showed similar results.
This national analysis of academic centers showed a low utilization of robotic-assisted laparoscopic elective general and bariatric surgical procedures with the highest utilization for rectal resection. Compared to conventional laparoscopy, there were no observed clinical benefits associated with the robotic approach, but there was a consistently higher cost.
机器人辅助的普通外科和减重手术在外科医生中越来越受欢迎。本研究的目的是分析在学术医疗中心进行的常见择期普通外科和减重手术中，腹腔镜技术与机器人辅助腹腔镜技术的应用情况及结果。
我们分析了大学卫生系统联盟临床数据库中2010年10月至2014年2月期间所有接受腹腔镜或机器人技术进行八种常见择期普通外科和减重手术的患者数据：胃旁路手术、袖状胃切除术、胃束带术、抗反流手术、海勒肌切开术（HM）、胆囊切除术（LC）、结肠切除术、直肠切除术（RR）。比较了两种技术在人口统计学、院内死亡率、主要并发症、30天再入院率、住院时间（LOS）和费用等方面的应用情况及结果指标。
共分析了96,694例腹腔镜和机器人手术。机器人手术方法在RR中的应用率最高（21.4%），其次是HM（9.1%）。所有手术中，腹腔镜技术与机器人技术在院内死亡率或主要并发症方面无显著差异。只有两种手术与机器人手术方法相关的结果有所改善：机器人HM和机器人LC与腹腔镜手术相比住院时间更短（分别为2.8±3.6天对2.3±2.1天；HM的p<0.05，以及2.9±2.4天对2.3±1.7天；LC的p<0.05）。所有手术中机器人组的费用显著更高（21%）。对病情轻度/中度患者的亚组分析显示了类似结果。
这项对学术中心的全国性分析表明，机器人辅助腹腔镜择期普通外科和减重手术的应用率较低，直肠切除术的应用率最高。与传统腹腔镜检查相比，未观察到机器人手术方法有临床益处，但成本始终较高。
