Buchs Nicolas C, Azagury Dan E, Pugin François, Jung Minoa K, Huber Olivier, Chassot Gilles, Morel Philippe
Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
Int J Med Robot. 2016 Jun;12(2):276-82. doi: 10.1002/rcs.1660. Epub 2015 Apr 19.
Super obese (SO) patients with a Body Mass Index (BMI) ≥ 50 kg/m(2) still represent a real anesthesiological and surgical challenge. While the best procedure to perform in this population remains unclear, robotic technology has been proposed to accomplish Roux-en-Y gastric bypass (RYGB). The study aim is to report our experience of robotic RYGB for SO patients and to compare it with open and laparoscopic surgery.
From July 1997 to March 2014, all consecutive RYGB cases for SO patients were collected in a dedicated database and reviewed retrospectively. Two hundred and fourteen SO patients were operated on: 65 by a robotic approach (30.4%), 54 by a laparoscopic approach (25.2%), and 95 using an open approach (44.4%). Peri- and post-operative data were compared between the three approaches.
There were more male patients in the robotic group, but with a slightly lower BMI. The operative time was longer for the robotic (+27 min) and laparoscopic (+21 min) groups in comparison with the open group (P < 0.05). Overall, there were less reoperations (P < 0.05) and a shorter hospital stay (P < 0.05) in the robotic group in comparison with other groups. Of note there was also a trend in favor of robotics with less conversions (P = 0.08) and less postoperative complications (P ≥ 0.05).
Robotic RYGB can be performed safely in super obese patients with results that compare favorably with laparoscopic and open surgery. However, the robotic approach has a longer operative time. The exact role of robotics for super obese population needs to be clarified in larger and randomized trials before drawing definitive conclusions. Copyright © 2015 John Wiley & Sons, Ltd.
体重指数（BMI）≥50kg/m²的超级肥胖（SO）患者仍然是麻醉和外科手术面临的一项实际挑战。虽然针对该人群的最佳手术方式仍不明确，但有人提出采用机器人技术来完成胃旁路手术（RYGB）。本研究旨在报告我们对SO患者进行机器人辅助RYGB手术的经验，并将其与开放手术和腹腔镜手术进行比较。
从1997年7月至2014年3月，所有连续的SO患者RYGB病例均收集到一个专用数据库中，并进行回顾性分析。214例SO患者接受了手术：65例采用机器人手术方式（30.4%），54例采用腹腔镜手术方式（25.2%），95例采用开放手术方式（44.4%）。比较三种手术方式的围手术期和术后数据。
机器人手术组男性患者较多，但BMI略低。与开放手术组相比，机器人手术组（+27分钟）和腹腔镜手术组（+21分钟）的手术时间更长（P<0.05）。总体而言，与其他组相比，机器人手术组再次手术较少（P<0.05），住院时间较短（P<0.05）。值得注意的是，在减少中转手术（P=0.08）和术后并发症方面（P≥0.05）也有支持机器人手术的趋势。
机器人辅助RYGB手术可在超级肥胖患者中安全进行，其效果与腹腔镜手术和开放手术相当。然而，机器人手术方式的手术时间较长。在得出明确结论之前，需要在更大规模的随机试验中明确机器人技术在超级肥胖人群中的具体作用。版权所有©2015约翰威立父子有限公司。
