Department of General Surgery, Kolding Hospital, Skovvangen 2-8, DK-6000 Kolding, Denmark.
Department of General Surgery, Kolding Hospital, Skovvangen 2-8, DK-6000 Kolding, Denmark.
Int J Surg. 2017 Mar;39:260-266. doi: 10.1016/j.ijsu.2017.02.014. Epub 2017 Feb 13.
Robot-assisted anti-reflux surgery (RAAS) is an alternative to conventional laparoscopic anti-reflux surgery (CLAS). The purpose of this study was to evaluate initial Danish experiences with robot-assisted anti-reflux surgery compared to conventional laparoscopic anti-reflux surgery incorporating follow-up and evaluation of possible learning curve.
Patients undergoing primary RAAS or CLAS at The Department of Surgery A, Odense University Hospital and The Department of General Surgery, Kolding Hospital from April 2013 to April 2015 was included. Demographic data, comorbidity, docking time, length of procedure, type of fundic wrap as well as perioperative complications and postoperative complications, need for reoperation or any upper gastrointestinal endoscopy from surgery to final follow-up was retrospectively extracted from patient records.
103 patients were included in this study. 39 patients underwent RAAS and 64 patients underwent CLAS. There were no statistically significant differences in demographic data or comorbidities except distribution of heart disease (RAAS: 5.1% vs. CLAS: 18.8%, p = 0.05) and previous abdominal surgery (RAAS: 28.2% vs. CLAS: 48.4%, p = 0.04). Duration of surgery was significantly increased in patients undergoing RAAS (RAAS: 135 ± 27 min vs. CLAS: 86 ± 19 min, p < 0.01). There was no statistical significant difference in intraoperative complications (p = 0.20), 30-day postoperative complication rate (p = 0.20) or mortality (p = 1.00). At follow-up in April 2016, there were no statistically significant differences in patients having undergone upper endoscopy postoperatively (p = 0.92), the use of anti-secretory drugs (p = 0.46) or patients having undergone reoperation (p = 0.60). Reasons for reoperation were significantly dependent on type of fundic wrap with reoperation of Nissen fundoplication being dysphagia and reoperation of Toupet being recurrent reflux (p = 0.008). There was no clearly determined learning curve.
RAAS was safe, feasible and with equal efficacy to CLAS. There were however no particular advantages to performing antireflux surgery as robot-assisted procedures neither intra-operatively nor at follow-up.
机器人辅助抗反流手术（RAAS）是传统腹腔镜抗反流手术（CLAS）的替代方法。本研究的目的是评估丹麦最初在机器人辅助抗反流手术方面的经验，包括随访和评估可能的学习曲线。
纳入 2013 年 4 月至 2015 年 4 月期间在奥登塞大学医院外科 A 部和科灵综合医院普外科接受初次 RAAS 或 CLAS 的患者。从病历中回顾性提取人口统计学数据、合并症、对接时间、手术时间、胃底包裹类型以及围手术期并发症和术后并发症、是否需要再次手术或任何上消化道内镜检查，直至最终随访。
本研究纳入 103 例患者。39 例患者接受 RAAS，64 例患者接受 CLAS。除心脏病分布（RAAS：5.1% vs. CLAS：18.8%，p=0.05）和既往腹部手术史（RAAS：28.2% vs. CLAS：48.4%，p=0.04）外，两组患者的人口统计学数据或合并症无统计学差异。RAAS 组的手术时间明显延长（RAAS：135±27 分钟 vs. CLAS：86±19 分钟，p<0.01）。术中并发症（p=0.20）、30 天术后并发症发生率（p=0.20）或死亡率（p=1.00）无统计学差异。2016 年 4 月随访时，两组术后行上消化道内镜检查（p=0.92）、使用抗分泌药物（p=0.46）或再次手术（p=0.60）患者无统计学差异。再次手术的原因与胃底包裹类型显著相关，尼森胃底折叠术的再次手术原因是吞咽困难，而图佩特胃底折叠术的再次手术原因是反流复发（p=0.008）。没有明确的学习曲线。
RAAS 是安全可行的，与 CLAS 疗效相当。但作为机器人辅助手术，无论是在手术中还是在随访中，反流手术都没有特别的优势。
