Strosberg David S, Nguyen Michelle C, Muscarella Peter, Narula Vimal K
Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 654, Columbus, OH, 43210, USA.
Montefiore M-E Center for Cancer Care, Bronx, NY, USA.
Surg Endosc. 2017 Mar;31(3):1436-1441. doi: 10.1007/s00464-016-5134-0. Epub 2016 Aug 5.
Robotic-assisted surgery is gaining popularity in general surgery. Our objective was to evaluate and compare operative outcomes and total costs for robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC).
A retrospective review was performed for all patients who underwent single-procedure RC and LC from January 2011 to July 2015 by a single surgeon at a large academic medical center. Demographics, diagnosis, perioperative variables, postoperative complications, 30-day readmissions, and operative and hospital costs were collected and analyzed between those patient groups.
A total of 237 patients underwent RC or LC, and comprised the study population. Ninety-seven patients (40.9 %) underwent LC, and 140 patients (50.1 %) underwent RC. Patients who underwent RC had a higher body mass index (p = 0.03), lower rates of coronary artery disease (p < 0.01), and higher rates of chronic cholecystitis (p < 0.01). There were lower rates of intraoperative cholangiography (p < 0.01) and conversion to an open procedure (p < 0.01), however longer operative times (p < 0.01) for patients in the RC group. There were no bile duct injuries in either group, no difference in bile leak rates (p = 0.65), or need for reoperation (p = 1.000). Cost analysis of outpatient-only procedures, excluding cases with conversion to open or use of intraoperative cholangiography, demonstrated higher total charges (p < 0.01) and cost (p < 0.01) and lower revenue (p < 0.01) for RC compared to LC, with no difference in total payments (p = 0.34).
Robotic cholecystectomy appears to be safe although costlier in comparison with laparoscopic cholecystectomy. Further studies are needed to understand the long-term implications of robotic technology, the cost to the health care system, and its role in minimally invasive surgery.
机器人辅助手术在普通外科中正逐渐受到欢迎。我们的目的是评估和比较机器人胆囊切除术（RC）和腹腔镜胆囊切除术（LC）的手术结果及总成本。
对2011年1月至2015年7月期间在一家大型学术医疗中心由同一位外科医生进行单例RC和LC手术的所有患者进行回顾性研究。收集并分析了这些患者组之间的人口统计学资料、诊断结果、围手术期变量、术后并发症、30天再入院情况以及手术和住院费用。
共有237例患者接受了RC或LC手术，构成了研究人群。97例患者（40.9%）接受了LC手术，140例患者（50.1%）接受了RC手术。接受RC手术的患者体重指数较高（p = 0.03），冠状动脉疾病发生率较低（p < 0.01），慢性胆囊炎发生率较高（p < 0.01）。RC组患者术中胆管造影率较低（p < 0.01），转为开放手术的比例较低（p < 0.01），但手术时间较长（p < 0.01）。两组均无胆管损伤，胆漏率无差异（p = 0.65），再次手术需求无差异（p = 1.000）。仅对门诊手术进行成本分析，排除转为开放手术或使用术中胆管造影的病例，结果显示与LC相比，RC的总费用更高（p < 0.01）、成本更高（p < 0.01）、收入更低（p < 0.01），总支付无差异（p = 0.34）。
机器人胆囊切除术似乎是安全的，尽管与腹腔镜胆囊切除术相比成本更高。需要进一步研究以了解机器人技术的长期影响、对医疗保健系统的成本及其在微创手术中的作用。
