Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
Surg Endosc. 2018 Jan;32(1):472-477. doi: 10.1007/s00464-017-5707-6. Epub 2017 Jul 19.
The purpose of this analysis is to compare the robotic EndoWrist Stapling System (EWSS) 45 mm (Intuitive Surgical Inc. Sunnyvale, CA, USA) and the ECHELON FLEX ENDOPATH Staplers (EFES) 60 mm (Ethicon, Cincinnati, OH, USA) for gastric pouch formation during robotic gastric bypass surgery.
Patients who underwent robotic gastric bypass surgery with stapling using EWSS were matched with patients who underwent the same procedure with the EFES. Demographic, intra- and postoperative, and cost data were collected and analyzed.
A total of 49 patients were identified who had undergone robotic gastric bypass surgery using EWSS. They were matched with 49 patients who underwent the equivalent procedure using EFES. With similar demographic parameters, corrected operating room time without cholecystectomy took longer for the patients that underwent surgery with EWSS (+22 min, p = 0.1042). Stapler clamping was unsuccessful in 19.0% of all recorded attempts with EWSS. Two intra-operative complications unrelated to stapling and one complication due to stapling were observed in the EWSS cohort, while none was observed for the EFES group. Significantly, more recharges were needed with EWSS to complete the gastric pouch (4.9 vs. 4.1, p = 0.0048) and overall stapling costs for the procedure were significantly higher (2212.2 vs. 1787.4 USD, p = 0.0001).
Gastric pouch formation using EWSS during robotic gastric bypass surgery is feasible. Due to the shorter length of EWSS compared to EFES, more stapling recharges are required to complete gastric pouch formation and the stapling costs for gastric bypass surgery are higher. Further systematic research should be conducted to precisely determine the value of the robotic EWSS for gastric bypass surgery.
本分析旨在比较机器人 EndoWrist 吻合系统（EWSS）45mm（美国加利福尼亚州森尼韦尔市直觉外科公司）和 ECHELON FLEX ENDOPATH 吻合器（EFES）60mm（美国俄亥俄州辛辛那提市爱惜康公司）在机器人胃旁路手术中胃小囊形成的效果。
对使用 EWSS 进行吻合的机器人胃旁路手术患者进行匹配，匹配对象为使用 EFES 进行相同手术的患者。收集并分析患者的人口统计学、围手术期和成本数据。
共确定 49 例接受 EWSS 机器人胃旁路手术的患者，他们与 49 例接受 EFES 等效手术的患者相匹配。在相似的人口统计学参数下，行 EWSS 手术的患者无胆囊切除术的校正手术室时间较长（+22 分钟，p=0.1042）。EWSS 所有记录尝试中有 19.0%的吻合器夹闭失败。在 EWSS 组中观察到 2 例与吻合无关的术中并发症和 1 例吻合相关的并发症，而 EFES 组则未观察到。显著的是，完成胃小囊需要更多的 EWSS 再充电（4.9 次比 4.1 次，p=0.0048），并且手术的总吻合成本显著更高（2212.2 美元比 1787.4 美元，p=0.0001）。
机器人胃旁路手术中使用 EWSS 进行胃小囊形成是可行的。由于 EWSS 的长度短于 EFES，因此需要更多的吻合器再充电来完成胃小囊的形成，并且胃旁路手术的吻合成本更高。应进一步进行系统研究，以准确确定机器人 EWSS 用于胃旁路手术的价值。
