Kelley Scott R, Duchalais Emilie, Larson David W
Am Surg. 2018 Nov 1;84(11):1768-1773.
Few series have reported on the impact of robotic right colectomy compared with conventional laparoscopy. Even fewer have reported on the outcomes of intracorporeal anastomoses. The aim of our study was to determine the impact of robotic surgery on short-term operative outcomes in patients undergoing right colectomy with intracorporeal anastomosis. One hundred and fourteen consecutive patients who underwent a right colectomy by two colorectal surgeons between 2012 and 2017 were included. Patients were separated into two groups: laparoscopic technique with extracorporeal anastomosis (n = 87) and robotic technique with intracorporeal anastomosis (n = 27). Univariate analysis was performed to determine differences in outcomes. Differences between cohorts were only identified with regard to gender (62 37%, = 0.022) and year of surgery. In comparison with laparoscopy, robotic colectomy resulted in a shorter time of GI recovery (1.3 ± 0.6 3 ± 1.1, < 0.0001), lower rates of postoperative ileus (4 28%, = 0.007), lower overall morbidity (26 52%, = 0.019), less blood loss ( = 0.001), 50 per cent lower narcotic use, and longer operative time (255 ± 66 139 ± 49, < 0.001). Despite longer operative time, robotic surgery improved GI recovery, significantly lowered oral morphine equivalent usage, and decreased short-term complications.
很少有系列研究报道机器人辅助右半结肠切除术与传统腹腔镜手术相比的影响。报道体内吻合术结果的研究更少。我们研究的目的是确定机器人手术对接受右半结肠切除体内吻合术患者短期手术结果的影响。纳入了2012年至2017年间由两位结直肠外科医生进行右半结肠切除术的114例连续患者。患者分为两组：体外吻合的腹腔镜技术组（n = 87）和体内吻合的机器人技术组（n = 27）。进行单因素分析以确定结果的差异。队列之间的差异仅在性别（62对37%，P = 0.022）和手术年份方面被发现。与腹腔镜手术相比，机器人辅助结肠切除术导致胃肠道恢复时间更短（1.3±0.6对3±1.1，P < 0.0001），术后肠梗阻发生率更低（4%对28%，P = 0.007），总体发病率更低（26%对52%，P = 0.019），失血量更少（P = 0.001），麻醉药物使用量降低50%，手术时间更长（255±66对139±49，P < 0.001）。尽管手术时间更长，但机器人手术改善了胃肠道恢复，显著降低了口服吗啡当量的使用，并减少了短期并发症。
