Holzmacher Jeremy L, Luka Samuel, Aziz Madiha, Amdur Richard L, Agarwal Samir, Obias Vincent
Department of Surgery, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
J Laparoendosc Adv Surg Tech A. 2017 Feb;27(2):151-155. doi: 10.1089/lap.2016.0409. Epub 2016 Nov 28.
To date there exists no published study examining the safety and efficacy of the EndoWrist 45 (Intuitive Surgical, Inc.) robotic stapler. We compared outcomes between the robotic and comparable laparoscopic stapler in robotic-assisted colorectal procedures.
We conducted a retrospective review of 93 patients who underwent robotic-assisted colorectal surgery at our institution from 2012 to 2014. Surgeries included left, sigmoid, subtotal and total colectomies, and low anterior rectal resections. Indications were malignancy and diverticular and inflammatory bowel disease. Preoperative demographics, intraoperative data, and postoperative outcomes were examined. Student's t-test and Fischer's exact used were appropriate.
Forty-five millimeters laparoscopic staplers were used in 58 cases, while the 45 mm robotic stapler was used in 35 cases. There was no difference in age (P = .651), gender (P = .832), or body mass index (P = .204) between groups. There was no difference in estimated blood loss (P = .524), operative time (P = .769), length of stay (P = .895), or complication rate (P = .778). The robotic stapler group had one anastomotic leak, while the laparoscopic stapler group had six (P = .705). There were more laparoscopic stapler fires (2.69) per patient than robotic stapler fires (1.86) (P = .001). The cost per patient for the laparoscopic group was $631.45 versus $473.28 for the robotic group (P = .001).
This is the first study to evaluate the robotic stapler. Advantages of the robotic stapler include large range of motion and 90° of articulation, which may provide a benefit when using the stapler in difficult areas like the pelvis. The robotic stapler has a comparable level of safety as a 45 mm laparoscopic stapler and is more cost effective.
迄今为止，尚无已发表的研究探讨EndoWrist 45（直观外科公司）机器人吻合器的安全性和有效性。我们比较了机器人辅助结直肠手术中机器人吻合器与类似腹腔镜吻合器的手术效果。
我们对2012年至2014年在本机构接受机器人辅助结直肠手术的93例患者进行了回顾性研究。手术包括左半结肠、乙状结肠、次全结肠和全结肠切除术，以及低位前直肠切除术。手术指征为恶性肿瘤、憩室病和炎症性肠病。对术前人口统计学资料、术中数据和术后结果进行了检查。采用学生t检验和费舍尔精确检验。
58例使用45毫米腹腔镜吻合器，35例使用45毫米机器人吻合器。两组患者在年龄（P = 0.651）、性别（P = 0.832）或体重指数（P = 0.204）方面无差异。估计失血量（P = 0.524）、手术时间（P = 0.769）、住院时间（P = 0.895）或并发症发生率（P = 0.778）方面也无差异。机器人吻合器组有1例吻合口漏，而腹腔镜吻合器组有6例（P = 0.705）。腹腔镜吻合器的患者人均击发次数（2.69次）多于机器人吻合器（1.86次）（P = 0.001）。腹腔镜组患者人均费用为631.45美元，而机器人组为473.28美元（P = 0.001）。
这是第一项评估机器人吻合器的研究。机器人吻合器的优点包括活动范围大及90°关节活动度，在骨盆等困难区域使用吻合器时可能具有优势。机器人吻合器与45毫米腹腔镜吻合器具有相当的安全性水平，且成本效益更高。
