Miller Peter E, Dao Haisar, Paluvoi Nivedh, Bailey Matthew, Margolin David, Shah Nishit, Vargas H D
Department of Surgery, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI.
Department of Surgery, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA.
J Am Coll Surg. 2016 Aug;223(2):369-73. doi: 10.1016/j.jamcollsurg.2016.03.041. Epub 2016 Apr 19.
The robotic platform has been used increasingly to perform colorectal surgery. The benefits of robotic colectomy when compared with laparoscopic colectomy have not been definitively established.
A retrospective review of the NSQIP database was performed on patients undergoing elective laparoscopic or robotic colectomy in 2013. Demographic characteristics, length of stay, operative time, and 30-day postoperative complications were compared between the 2 groups.
Of the 17,774 colectomies performed during the study period, 11,267 (63.4%) were performed laparoscopically and 653 (3.7%) were performed robotically. In comparison with laparoscopic colectomy, robotic colectomy was associated with increased operative time (233 vs 180 minutes; p < 0.01) and decreased length of stay (5.04 vs 6.06 days; p < 0.01). There was no significant difference with respect to mortality (0.2% vs 0.4%; p < 0.312), anastomotic leak (3.4% vs 3.1%; p = 0.715), reoperation (4.9% vs 4.0%; p = 0.27), conversion (10.3% vs 12.2%; p = 0.13), or readmission (9.3% vs 8.7%; p = 0.593) rates. The differences in length of stay and operative time persisted in the right colectomy and left colectomy/sigmoid resection subgroup analysis with no difference in conversion rates.
In this head-to-head comparison of laparoscopic colectomy and robotic colectomy, the majority of postoperative outcomes were equivalent, except for an increase in operative time and shorter length of stay in the robotic group. Robotic colectomy appears to be a safe option for minimally invasive colectomy, but additional studies are needed to elucidate whether it is cost-effective when compared with laparoscopic colectomy.
机器人平台已越来越多地用于结直肠手术。与腹腔镜结肠切除术相比，机器人结肠切除术的益处尚未明确确立。
对2013年接受择期腹腔镜或机器人结肠切除术的患者进行NSQIP数据库的回顾性分析。比较两组患者的人口统计学特征、住院时间、手术时间和术后30天并发症。
在研究期间进行的17774例结肠切除术中，11267例（63.4%）为腹腔镜手术，653例（3.7%）为机器人手术。与腹腔镜结肠切除术相比，机器人结肠切除术的手术时间延长（233分钟对180分钟；p<0.01），住院时间缩短（5.04天对6.06天；p<0.01）。在死亡率（0.2%对0.4%；p<0.312）、吻合口漏（3.4%对3.1%；p=0.715）、再次手术（4.9%对4.0%；p=0.27）、中转（10.3%对12.2%；p=0.13）或再入院率（9.3%对8.7%；p=0.593）方面无显著差异。在右半结肠切除术和左半结肠切除术/乙状结肠切除术亚组分析中，住院时间和手术时间的差异仍然存在，中转率无差异。
在腹腔镜结肠切除术和机器人结肠切除术的直接比较中，除机器人组手术时间延长和住院时间缩短外，大多数术后结果相当。机器人结肠切除术似乎是微创结肠切除术的一种安全选择，但需要进一步研究以阐明与腹腔镜结肠切除术相比其是否具有成本效益。
