Harr Jeffrey N, Luka Samuel, Kankaria Aman, Juo Yen-Yi, Agarwal Samir, Obias Vincent
Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
University of Maryland at College Park, College Park, MD, USA.
Surg Endosc. 2017 Jul;31(7):2813-2819. doi: 10.1007/s00464-016-5291-1. Epub 2016 Oct 27.
Reports demonstrate laparoscopic colorectal surgery in obese patients is associated with higher conversion to laparotomy and complication rates. While several advantages of robotic-assisted surgery have been reported, outcomes in obese patients have not been adequately studied. Therefore, this study compares outcomes of robotic-assisted surgery in non-obese and obese patients.
A retrospective review of 331 consecutive robotic procedures performed at a single institution between 2009 and 2015 was performed. Patients were divided into non-obese (BMI <30 kg/m) and obese (BMI ≥30 kg/m) groups, and were clinically matched by gender, age, and procedure performed. Intraoperative and postoperative complications, operative time, estimated blood loss, and length of stay were examined.
Following matching, each group included 108 patients comprised of 50 men and 58 women. Mean BMI was 24.6 ± 3.15 and 36.2 ± 5.67 kg/m (p < 0.0001), and the mean age was 59.2 ± 11.28 years for non-obese patients and 57.1 ± 12.44 for obese patients (p = 0.18). Surgeries included low anterior resection, right colectomy, left colectomy, sigmoid colectomy, excision of rectal endometriosis, total proctocolectomy, APR, subtotal colectomy, ileocecectomy, proctectomy, rectopexy, transanal excision of rectal mass, and colostomy site hernia repair. The mean operative time was 272.69 ± 115.43 and 282.42 ± 120.51 min (p = 0.55), estimated blood loss 195.23 ± 230.37 and 289.19 ± 509.27 mL (p = 0.08), conversion to laparotomy 6.48 and 9.26 % (p = 0.45), and length of stay 5.38 ± 4.94 and 4.56 ± 4.04 days (p = 0.18) for the non-obese and obese groups, respectively. Twenty of the non-obese patients had postoperative complications as compared to 27 of the obese patients (p = 0.30). However, the prevalence of wound complications was higher in obese patients (1.9 vs 9.3 %; p = 0.03).
There is no difference in conversion to laparotomy and overall complication rates in non-obese and obese patients undergoing robotic-assisted colorectal surgery. However, obesity is associated with a higher prevalence of wound complications. Robotic-assisted surgery may minimize conversion to laparotomy and complications typically seen in obese patients due to improved visualization, instrumentation, and ergonomics.
报告显示，肥胖患者的腹腔镜结直肠手术与更高的剖腹手术转化率和并发症发生率相关。虽然已有报道指出机器人辅助手术有诸多优势，但肥胖患者的手术效果尚未得到充分研究。因此，本研究比较了非肥胖和肥胖患者机器人辅助手术的效果。
对2009年至2015年间在单一机构进行的331例连续机器人手术进行回顾性分析。患者分为非肥胖（BMI<30kg/m²）和肥胖（BMI≥30kg/m²）两组，并根据性别、年龄和所行手术进行临床匹配。检查术中及术后并发症、手术时间、估计失血量和住院时间。
匹配后，每组包括108例患者，其中男性50例，女性58例。非肥胖患者的平均BMI为24.6±3.15kg/m²，肥胖患者为36.2±5.67kg/m²（p<0.0001）；非肥胖患者的平均年龄为59.2±11.28岁，肥胖患者为57.1±12.44岁（p=0.18）。手术包括低位前切除术、右半结肠切除术、左半结肠切除术、乙状结肠切除术、直肠子宫内膜异位症切除术、全直肠结肠切除术、腹会阴联合直肠癌根治术、次全结肠切除术、回盲部切除术、直肠切除术、直肠固定术、经肛门直肠肿物切除术和结肠造口旁疝修补术。非肥胖组和肥胖组的平均手术时间分别为272.69±115.43分钟和282.42±120.51分钟（p=0.55），估计失血量分别为195.23±230.37毫升和289.19±509.27毫升（p=0.08），剖腹手术转化率分别为6.48%和9.26%（p=0.45），住院时间分别为5.38±4.94天和4.56±4.04天（p=0.18）。非肥胖组有20例患者出现术后并发症，肥胖组为27例（p=0.30）。然而，肥胖患者伤口并发症的发生率更高（1.9%对9.3%；p=0.03）。
接受机器人辅助结直肠手术的非肥胖和肥胖患者在剖腹手术转化率和总体并发症发生率方面没有差异。然而，肥胖与更高的伤口并发症发生率相关。机器人辅助手术可能因改善了视野、器械操作和人体工程学，将肥胖患者常见的剖腹手术转化率和并发症降至最低。
