Damle Aneel, Damle Rachelle N, Flahive Julie M, Schlussel Andrew T, Davids Jennifer S, Sturrock Paul R, Maykel Justin A, Alavi Karim
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Am J Surg. 2017 Nov;214(5):820-824. doi: 10.1016/j.amjsurg.2017.03.020. Epub 2017 Mar 21.
Following FDA approval, robotic-assisted colorectal surgery (RACS) has increased in prevalence. We aimed to identify trends in utilization and patient characteristics of RACS in the United States using the University HealthSystem Consortium database between October 2011-September 2015. Outcome measures were number and percentage of procedures performed with robotic-assistance. 7100 patients were identified. The most common procedures were low anterior resection, sigmoid colectomy, abdominoperineal resection, right colectomy, rectopexy, left colectomy, and total colectomy. There was a 158% increase in RACS procedures. As a percentage of all approaches, RACS increased from 2.6% to 6.6%. The number of centers performing RACS increased from 105 to 140. Over the study period, the complexity of patients increased, with the percentage of patients with ≥3 comorbidities rising from 18% to 24% (p = 0.03) and patients with a moderate severity of illness score increasing from 35% to 41% (p = 0.04). RACS has expanded significantly in volume, number of centers, and patient selection. Further studies evaluating outcomes and cost of RACS are required to determine whether these increases are justified by improved clinical outcomes.
在美国食品药品监督管理局（FDA）批准后，机器人辅助结直肠手术（RACS）的普及率有所上升。我们旨在利用大学卫生系统联盟数据库，确定2011年10月至2015年9月期间美国RACS的使用趋势和患者特征。结果指标为机器人辅助手术的数量和百分比。共识别出7100名患者。最常见的手术是低位前切除术、乙状结肠切除术、腹会阴联合切除术、右半结肠切除术、直肠固定术、左半结肠切除术和全结肠切除术。RACS手术增加了158%。作为所有手术方式的百分比，RACS从2.6%增至6.6%。开展RACS的中心数量从105个增至140个。在研究期间，患者的病情复杂性增加，合并症≥3种的患者百分比从18%升至24%（p = 0.03），疾病严重程度为中度的患者百分比从35%升至41%（p = 0.04）。RACS在手术量、中心数量和患者选择方面均有显著扩展。需要进一步研究评估RACS的疗效和成本，以确定这些增长是否因临床疗效改善而合理。
