Ryan Carrie E, Ross Sharona B, Sukharamwala Prashant B, Sadowitz Benjamin D, Wood Thomas W, Rosemurgy Alexander S
Florida Hospital Tampa.
JSLS. 2015 Jan-Mar;19(1):e2014.00246. doi: 10.4293/JSLS.2014.00246.
The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy.
With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD.
Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery.
Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.
机器人手术的作用和应用存在争议，尤其是考虑到腹腔镜手术的扩展，特别是腹腔镜单孔手术（LESS）。本队列研究旨在描述LESS与机器人远端胰腺切除术和脾切除术在手术结果上的差异。
经机构审查委员会批准，对2012年9月1日至2014年12月31日期间接受LESS或机器人远端胰腺切除术和脾切除术的患者进行前瞻性观察，并收集数据。结果以中位数表示，同时给出均值±标准差。
34例患者接受了微创远端胰腺切除术和脾切除术：18例接受机器人手术，16例接受LESS手术。患者在性别、年龄和体重指数方面相似。转为开放手术的比例和估计失血量相似。接受机器人手术的组中有2例术中并发症。机器人手术在手术室花费的时间明显更长（297分钟对254分钟，P = 0.03），尽管手术持续时间（即从切开到缝合）并不更长（225分钟对190分钟；P = 0.15）。在所研究的手术中，79%是针对肿瘤性疾病进行的。两种手术方式的肿瘤大小均为3.5 cm；所有患者均实现了R0切除。两个研究组的住院时间相似（5天对4天）。机器人手术后有1例患者在30天内再次入院。
LESS或机器人远端胰腺切除术和脾切除术的患者手术结果相似。机器人手术在手术室需要更多时间。两者都是安全有效的微创手术，对于相似的肿瘤遵循相似的肿瘤学原则，并且都应成为外科医生进行远端胰腺切除术和脾切除术的技术手段。
