Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
Surg Endosc. 2018 Apr;32(4):2106-2113. doi: 10.1007/s00464-017-5908-z. Epub 2017 Oct 24.
Utilization of laparoscopy (LAP) has been increasing in general surgery for years, and there is currently a rapid increase in the utilization of robotic-assisted surgeries (RAS). This study evaluates trends in the surgical approach utilized in some commonly performed surgeries, the proportion of each approach within the procedures, and the cost of these surgeries based on the surgical approach.
This is a retrospective study using the Vizient database. The database was queried using ICD-9 codes for colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric surgeries, either open, LAP, or robotically performed. Utilization trends were evaluated between quarters, over a 7-year period, and direct cost was compared between approaches. IBM SPSS v.23.0.0 was used for data analysis, with α = 0.05.
857,468 patients underwent colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric procedures. A significant decrease in open-approach utilization was seen in colectomy (71.8-61.9%), cholecystectomy (35.7-27.1%), and bariatric surgeries (20.1-10.1%), whereas both LAP and RAS utilization increased (p < 0.001). Significant RAS increase was seen in all five procedures: colectomy (0.4-8.0%), cholecystectomy (0.2-1.8%), IHR (19.9-29.4%), VHR (0.2-2.9%), and bariatric (0.6-5.4%), compared to a decrease in LAP (p < 0.001). Surgery cost was significantly higher for open ($14,364), followed by RAS ($11,376) and LAP ($7945), p < 0.001.
Robotic technology is commonly viewed as enabling open procedures to be converted to minimally invasive, a trend not observed in our study. Our trends analysis revealed significant RAS utilization increase from LAP procedures and not from open procedure conversion, although specific surgeon data were not available. RAS were costlier than LAP for all five procedures. The benefits of rapid robot adoption and the forces that are driving these must be examined against a backdrop of burdening an already expensive healthcare system.
腹腔镜（LAP）在普通外科中的应用多年来一直在增加，而机器人辅助手术（RAS）的应用正在迅速增加。本研究评估了一些常见手术中所采用的手术方法的趋势，每种方法在手术中的比例，以及基于手术方法的手术成本。
这是一项使用 Vizient 数据库的回顾性研究。使用 ICD-9 代码对结肠切除术、胆囊切除术、腹股沟和腹侧疝修补术以及减重手术进行数据库查询，这些手术可以是开放的、LAP 或机器人辅助的。在 7 年的时间里，每季度评估利用趋势，并比较不同方法的直接成本。使用 IBM SPSS v.23.0.0 进行数据分析，α=0.05。
857468 例患者接受了结肠切除术、胆囊切除术、腹股沟和腹侧疝修补术以及减重手术。结肠切除术（71.8-61.9%）、胆囊切除术（35.7-27.1%）和减重手术（20.1-10.1%）中开放手术的利用率显著下降，而 LAP 和 RAS 的利用率均有所增加（p<0.001）。所有五项手术中 RAS 的利用率均显著增加：结肠切除术（0.4-8.0%）、胆囊切除术（0.2-1.8%）、IHR（19.9-29.4%）、VHR（0.2-2.9%）和减重手术（0.6-5.4%），而 LAP 的利用率则下降（p<0.001）。手术成本明显更高开放（$14364），其次是 RAS（$11376）和 LAP（$7945），p<0.001。
机器人技术通常被认为可以将开放手术转化为微创手术，但我们的趋势分析并未发现这种情况。我们的趋势分析显示，RAS 的利用显著增加，来自 LAP 手术，而不是来自开放手术的转换，尽管没有提供具体的外科医生数据。对于所有五项手术，RAS 的成本都高于 LAP。必须在已经昂贵的医疗保健系统的背景下，审查快速采用机器人技术的好处和推动这些技术发展的力量。
