Department of Surgery, Loma Linda University, Loma Linda, CA, USA.
Department of Surgery, Veterans Administration Hospital Loma Linda, Loma Linda, CA, USA.
J Robot Surg. 2019 Jun;13(3):429-434. doi: 10.1007/s11701-018-0887-1. Epub 2018 Nov 13.
Crohn's disease is an incurable inflammatory disorder that can affect the entire gastrointestinal tract. While medical management is considered first-line treatment, approximately 70-90% of patients with Crohn's disease will require at least one surgical intervention during the course of their lifetimes. Traditionally, abdominal surgery for Crohn's disease has been performed via an open approach with an increasing adoption of minimally invasive techniques. The aim of this study was to evaluate and compare postoperative outcomes from an initial national experience with robotic-assisted ileocolic resection for Crohn's disease. Patients who underwent elective ileocolic resection for Crohn's disease by robotic-assisted or open approaches from 2011 to Q3 2015 were identified using ICD-9 codes from the Premier Healthcare Database. Propensity-score matching (1:1) was performed using age, gender, race, Charlson index score, and year of surgery to form comparable cohorts in order to compare the robotic-assisted and open groups. 3641 patients underwent elective ileocolic resection for Crohn's disease during the study period (1910 [52.5%] open and 109 [3%] robotic-assisted). Post-matched comparison of cohorts (n = 108 per cohort) showed that robotic-assisted cases were longer by a mean of 60 min (p < 0.0001), had shorter length of hospital stay by a median of 2 days (p < 0.001) and a lower 30-day complication rate (24% vs. 38%; p = 0.039). This national database assessment of patients undergoing elective ileocolic resection for Crohn's disease demonstrated that a robotic-assisted approach was associated with longer operative times, shorter length of hospital stay and lower 30-day complication rates compared to open approach.
克罗恩病是一种无法治愈的炎症性疾病，可影响整个胃肠道。虽然医学治疗被认为是首选治疗方法，但大约 70-90%的克罗恩病患者在其一生中至少需要进行一次手术干预。传统上，克罗恩病的腹部手术采用开放方式进行，微创技术的应用越来越多。本研究旨在评估和比较初次全国性机器人辅助回结肠切除术治疗克罗恩病的术后结果。使用 Premier Healthcare Database 中的 ICD-9 代码，确定了 2011 年至 2015 年第三季度期间，通过机器人辅助或开放方法接受择期回结肠切除术治疗克罗恩病的患者。使用年龄、性别、种族、Charlson 指数评分和手术年份进行倾向评分匹配（1:1），以形成可比队列，比较机器人辅助组和开放组。研究期间共有 3641 例患者接受择期回结肠切除术治疗克罗恩病（1910 例[52.5%]采用开放方法，109 例[3%]采用机器人辅助）。对匹配后的队列（每组 108 例）进行比较，结果显示机器人辅助组的手术时间平均延长 60 分钟（p<0.0001），中位住院时间缩短 2 天（p<0.001），30 天并发症发生率降低（24% vs. 38%；p=0.039）。这项针对接受择期回结肠切除术治疗克罗恩病患者的全国性数据库评估表明，与开放方法相比，机器人辅助方法与较长的手术时间、较短的住院时间和较低的 30 天并发症发生率相关。
