Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA.
Surg Endosc. 2019 Mar;33(3):917-922. doi: 10.1007/s00464-018-6387-6. Epub 2018 Aug 20.
Laparoscopic sleeve gastrectomy has become the procedure of choice for the treatment of morbid obesity. Robotic sleeve gastrectomy is an alternative surgical option, but its utilization has been low. The aim of this study was to evaluate the contemporary outcomes of robotic sleeve gastrectomy (RSG) versus laparoscopic sleeve gastrectomy (LSG) using a national database from accredited bariatric centers.
Using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, clinical data for patients who underwent RSG or LSG were examined. Emergent and revisional cases were excluded. A multivariate logistic regression model was utilized to compare the outcomes between RSG and LSG.
A total of 75,079 patients underwent sleeve gastrectomy with 70,298 (93.6%) LSG and 4781 (6.4%) RSG. Preoperative sleep apnea and hypoalbumenia were significantly higher in the RSG group (P < 0.01). Mean length of stay was similar between RSG and LSG (1.8 ± 2.0 vs. 1.7 ± 2.0 days, P = 0.17). Operative time was longer in the RSG group (102 ± 43 vs. 74 ± 36 min, P < 0.01). There was no significant difference in 30-day mortality between the RSG versus LSG group (0.02% vs. 0.01%, AOR 0.85; 95% CI 0.11-6.46, P = 0.88). However, RSG was associated with higher serious morbidity (1.1% vs. 0.8%, AOR 1.40; 95% CI 1.05-1.86, P < 0.01), higher leak rate (1.5% vs. 0.5%, AOR 3.14; 95% CI 2.65-4.42, P < 0.01), and higher surgical site infection rate (0.7% vs. 0.4%, AOR 1.55; 95% CI 1.08-2.23, P = 0.01).
Robotic sleeve gastrectomy has longer operative time and is associated with higher postoperative morbidity including leak and surgical site infections. Laparoscopy should continue to be the surgical approach of choice for sleeve gastrectomy.
腹腔镜袖状胃切除术已成为治疗病态肥胖的首选方法。机器人袖状胃切除术是一种替代手术选择，但利用率较低。本研究旨在使用经过认证的减重中心的国家数据库，评估机器人袖状胃切除术（RSG）与腹腔镜袖状胃切除术（LSG）的当代结果。
使用 2015 年代谢和减重手术认证和质量改进计划（MBSAQIP）数据库，检查了接受 RSG 或 LSG 的患者的临床数据。排除了紧急和修订病例。使用多变量逻辑回归模型比较 RSG 和 LSG 之间的结果。
共有 75079 例患者接受了袖状胃切除术，其中 70298 例（93.6%）接受了 LSG，4781 例（6.4%）接受了 RSG。RSG 组术前睡眠呼吸暂停和低白蛋白血症明显更高（P < 0.01）。RSG 和 LSG 之间的平均住院时间相似（1.8 ± 2.0 天 vs. 1.7 ± 2.0 天，P = 0.17）。RSG 组的手术时间更长（102 ± 43 分钟 vs. 74 ± 36 分钟，P < 0.01）。RSG 组与 LSG 组在 30 天死亡率方面无显著差异（0.02% vs. 0.01%，AOR 0.85；95%CI 0.11-6.46，P = 0.88）。然而，RSG 与更高的严重发病率相关（1.1% vs. 0.8%，AOR 1.40；95%CI 1.05-1.86，P < 0.01），更高的漏率（1.5% vs. 0.5%，AOR 3.14；95%CI 2.65-4.42，P < 0.01）和更高的手术部位感染率（0.7% vs. 0.4%，AOR 1.55；95%CI 1.08-2.23，P = 0.01）。
机器人袖状胃切除术的手术时间更长，术后发病率较高，包括漏和手术部位感染。腹腔镜应继续作为袖状胃切除术的首选手术方法。
