Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan.
Clinical Affairs, Intuitive Surgical, Inc, Sunnyvale, California.
Ann Thorac Surg. 2018 Sep;106(3):902-908. doi: 10.1016/j.athoracsur.2018.03.048. Epub 2018 Apr 25.
Reports of surgical outcomes comparing proficient surgeons who perform either robotic-assisted or video-assisted thoracoscopic lobectomy are lacking. We evaluate the comparative effectiveness of robotic-assisted and video-assisted thoracoscopic lobectomies by surgeons who performed 20 or more annual surgical procedures in a national database.
Patients 18 years or older, who underwent elective lobectomy by surgeons who performed 20 or more annual lobectomies by robotic-assisted or thoracoscopic approach from January 2011 through September 2015, were identified in the Premier Healthcare database with the use of codes from the ninth revision of the International Statistical Classification of Diseases and Related Health Problems. Propensity-score matching based on patient and hospital characteristics and by year was performed 1:1 to identify comparable cohorts for analysis (n = 838 in each cohort). All tests were two-sided, with statistical significance set at p less than 0.05.
A total of 23,779 patients received an elective lobectomy during the study period: 9,360 were performed by video-assisted thoracoscopic approach and 2,994 were by robotic-assisted approach. Propensity-matched comparison of lobectomies performed by surgeons who performed 20 or more procedures annually (n = 838) showed that robotic-assisted procedures had a longer mean operative time by 25 minutes (mean 247.1 minutes vs 222.6 minutes, p < 0.0001) but had a lower conversion-to-open rate (4.8% vs 8.0%, p = 0.007) and a lower 30-day complication rate (33.4% vs 39.2%, p = 0.0128). Transfusion rates and 30-day mortality rates were similar between the two cohorts.
When surgical outcomes are limited to surgeons who perform 20 or more annual procedures, the robotic-assisted approach is associated with a lower conversion-to-open rate and lower 30-day complication rate when than video-assisted thoracoscopic surgeons, with a mean operative time difference of 25 minutes.
缺乏熟练外科医生行机器人辅助或电视辅助胸腔镜肺叶切除术的手术结果比较报告。我们在全国数据库中评估了 20 次或更多年度手术的外科医生行机器人辅助和电视辅助胸腔镜肺叶切除术的比较效果。
从 2011 年 1 月至 2015 年 9 月，在 Premier Healthcare 数据库中，使用国际疾病分类第九版和相关健康问题的国际统计分类代码，确定了 18 岁或以上的接受择期肺叶切除术的患者，这些患者由采用机器人辅助或胸腔镜方法进行 20 次或更多肺叶切除术的外科医生进行。通过患者和医院特征以及年度进行倾向评分匹配，以 1:1 的比例对分析进行匹配（每个队列各 838 例）。所有检验均为双侧检验，p 值小于 0.05 为差异有统计学意义。
在研究期间，共有 23779 例患者接受了择期肺叶切除术：9360 例由电视辅助胸腔镜方法进行，2994 例由机器人辅助方法进行。对每年进行 20 次或更多手术的外科医生进行的肺叶切除术的倾向评分匹配比较（n=838）显示，机器人辅助手术的平均手术时间延长了 25 分钟（平均 247.1 分钟 vs 222.6 分钟，p<0.0001），但中转开胸率较低（4.8% vs 8.0%，p=0.007），30 天并发症发生率较低（33.4% vs 39.2%，p=0.0128）。两组患者的输血率和 30 天死亡率相似。
当手术结果仅限于每年进行 20 次或更多手术的外科医生时，与电视辅助胸腔镜外科医生相比，机器人辅助方法与较低的中转开胸率和较低的 30 天并发症率相关，平均手术时间差为 25 分钟。
