Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave, A1027, New York, NY, 10065, USA.
, New York, NY, USA.
Obes Surg. 2018 Jul;28(7):1852-1859. doi: 10.1007/s11695-018-3119-x.
Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS).
Retrospective review was conducted of adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to December 2016. Patients undergoing planned two-stage bariatric procedures were excluded.
A total of 84 patients who underwent LRBS (n = 66) or RRBS (n = 18) were included. The index operation was adjustable gastric banding (AGB) in 39/84 (46%), sleeve gastrectomy (VSG) in 23/84 (27%), Roux-en-Y gastric bypass (RYGB) in 13/84 (16%), and vertical banded gastroplasty (VBG) in 9/84 (11%). For patients undergoing conversion from AGB (n = 39), there was no difference in operative time, length of stay, or complications by surgical approach. For patients undergoing conversion from a stapled procedure (n = 45), the robotic approach was associated with a shorter length of stay (5.8 ± 3.3 vs 3.7 ± 1.7 days, p = 0.04) with equivalent operative time and post-operative complications. There were three leaks in the LRBS group and none in the RRBS group (p = 0.36). Major complications occurred in 3/39 (8%) of patients undergoing conversion from AGB and 2/45 (4%) of patients undergoing conversion from a stapled procedure (p = 0.53) with no difference by surgical approach.
RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.
机器人平台的应用在减重手术中越来越普遍。我们旨在表明，机器人减重手术（RRBS）可在复杂的患者人群中安全进行，其围手术期结果与腹腔镜减重手术（LRBS）相当。
对 2007 年 9 月至 2016 年 12 月在我院接受腹腔镜减重手术（LRBS）或机器人减重手术（RRBS）的成年患者进行回顾性分析。排除计划进行两阶段减重手术的患者。
共纳入 84 例患者，其中行 LRBS（n=66）或 RRBS（n=18）。索引手术为可调胃束带术（AGB）39/84（46%）、袖状胃切除术（VSG）23/84（27%）、胃旁路术（RYGB）13/84（16%）和垂直带胃成形术（VBG）9/84（11%）。对于行 AGB 转为手术的患者（n=39），手术方式不同，手术时间、住院时间或并发症无差异。对于行吻合器吻合术转为手术的患者（n=45），机器人手术方式与较短的住院时间相关（5.8±3.3 与 3.7±1.7 天，p=0.04），手术时间和术后并发症无差异。LRBS 组有 3 例漏诊，RRBS 组无漏诊（p=0.36）。AGB 转为手术的 39 例患者中有 3 例（8%）和吻合器吻合术转为手术的 45 例患者中有 2 例（4%）发生重大并发症（p=0.53），手术方式无差异。
RRBS 与 LRBS 相比，在复杂手术中住院时间较短，且至少具有相当的安全性。需要长期随访数据。
