Mark-Christensen Anders, Pachler Frederik Rønne, Nørager Charlotte Buchard, Jepsen Peter, Laurberg Søren, Tøttrup Anders
1 Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark 2 Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark 3 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Dis Colon Rectum. 2016 Mar;59(3):201-7. doi: 10.1097/DCR.0000000000000540.
The potential advantages of robot-assisted laparoscopy are being increasingly investigated, although data on its efficacy in benign colorectal surgery are scarce.
We compared the early postoperative outcome in robot-assisted IPAA with open surgery procedures.
This was an observational study based on prospectively collected data obtained from chart reviews.
The single-center data set covers patients operated on from January 13, 2004, to September 16, 2014, at a specialist center.
Patients with ulcerative colitis undergoing IPAA surgery were included.
Study end points included the duration of operation, admission length, complications (Clavien-Dindo), reoperations, and readmissions.
Eighty-one robot-assisted and 170 open IPAA procedures were performed. The duration of operation was significantly longer for robot-assisted laparoscopic procedures (mean difference, 154 minutes; CI, 140-170). During a mean follow-up of 102 days, no significant differences in the distribution of complications were found (Spearman p = 0.12; p = 0.07), and no postoperative deaths occurred in either group. Postoperative admission length was shorter following robot-assisted procedures (mean difference, -1.9; CI, -3.5 to -0.3), whereas 40% of patients were readmitted, compared with 26% of patients who had open surgery (OR, 1.9; CI, 1.1-3.4). Pouch failure occurred in 3 patients (1 following robot-assisted laparoscopy; 2 following open surgery). On multivariate regression analyses, robot-assisted laparoscopy was associated with a significantly longer duration of operation (mean difference, 159 minutes; CI, 144-174), and more readmissions for any cause (OR, 2; CI, 1.1-3.7).
This was a nonrandomized, single-center observational study.
In this implementation phase, robot-assisted IPAA surgery offers acceptable short-term outcomes. The limitations of this observational study call for randomized controlled trials with long-term follow-up and exploration of functional results.
尽管机器人辅助腹腔镜手术在良性结直肠手术中的疗效数据稀缺，但对其潜在优势的研究日益增多。
我们比较了机器人辅助回肠袋肛管吻合术（IPAA）与开放手术的术后早期结局。
这是一项基于前瞻性收集的病历审查数据的观察性研究。
单中心数据集涵盖了2004年1月13日至2014年9月16日在一家专科中心接受手术的患者。
纳入接受IPAA手术的溃疡性结肠炎患者。
研究终点包括手术时长、住院时间、并发症（Clavien-Dindo分级）、再次手术和再次入院情况。
共进行了81例机器人辅助IPAA手术和170例开放IPAA手术。机器人辅助腹腔镜手术的手术时长显著更长（平均差值154分钟；可信区间，140 - 170）。在平均102天的随访期间，两组并发症分布无显著差异（Spearman p = 0.12；p = 0.07），且两组均未发生术后死亡。机器人辅助手术后的术后住院时间更短（平均差值，-1.9；可信区间，-3.5至-0.3），然而，40%的患者再次入院，而开放手术患者的这一比例为26%（比值比，1.9；可信区间，1.1 - 3.4）。3例患者出现储袋功能障碍（机器人辅助腹腔镜手术后1例；开放手术后2例）。多因素回归分析显示，机器人辅助腹腔镜手术与显著更长的手术时长（平均差值159分钟；可信区间，144 - 174）以及因任何原因导致的更多再次入院相关（比值比，2；可信区间，1.1 - 3.7）。
这是一项非随机、单中心观察性研究。
在这个实施阶段，机器人辅助IPAA手术提供了可接受的短期结局。这项观察性研究的局限性需要通过长期随访的随机对照试验以及对功能结果的探索来解决。
