Beltzer Christian, Knoerzer Lisa, Bachmann Robert, Axt Steffen, Dippel Hartmut, Schmidt Roland
Department of General, Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany.
Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Tübingen, Germany.
J Laparoendosc Adv Surg Tech A. 2019 Nov;29(11):1451-1455. doi: 10.1089/lap.2019.0451. Epub 2019 Aug 21.
Laparoscopic sigmoid resection is the surgical standard for the treatment of diverticulitis. Robotic sigmoid resection with the da Vinci Xi platform may offer advantages over the laparoscopic approach. One hundred and six patients with uncomplicated, complicated, or recurrent diverticular disease underwent robotic ( = 60) or laparoscopic ( = 46) sigmoid resection at our institution between 2013 and 2018. Patient demographics and characteristics, perioperative measures, and complications were retrospectively analyzed. There were no statistically significant differences between the robotic and laparoscopic group with regard to operative time (130 versus 118 minutes; = .23), anastomotic leakage (6.7% versus 6.5%; = 1.0), need for stoma (6.7% versus 4.3%; = 1.0), conversion rate (1.7% versus 0%; = .36), reoperation (8.3% versus 15.2%; = .27), overall complications according to the Clavien-Dindo classification (30.0% versus 30.4%; = .8), mortality (1.7% versus 0%; = 1.0), and need for intravenous analgesics (3.0 versus 2.1 days; = .21). The duration of postoperative ileus was significantly shorter in the robotic group (2.2 versus 2.8 days; = .01). Robotic sigmoid resection for uncomplicated, complicated, or recurrent diverticular disease is a safe and feasible procedure. However, robotic sigmoid resection for diverticulitis is not associated with relevant clinical benefits for patients compared to laparoscopic resection except for a slightly shorter duration of postoperative ileus.
腹腔镜乙状结肠切除术是治疗憩室炎的手术标准。使用达芬奇Xi平台进行机器人辅助乙状结肠切除术可能比腹腔镜手术具有优势。2013年至2018年期间，我院106例患有单纯性、复杂性或复发性憩室病的患者接受了机器人辅助（n = 60）或腹腔镜（n = 46）乙状结肠切除术。对患者的人口统计学和特征、围手术期指标及并发症进行了回顾性分析。机器人辅助组和腹腔镜组在手术时间（130分钟对118分钟；P = 0.23）、吻合口漏（6.7%对6.5%；P = 1.0）、造口需求（6.7%对4.3%；P = 1.0）、中转率（1.7%对0%；P = 0.36）、再次手术率（8.3%对15.2%；P = 0.27）、根据Clavien-Dindo分类的总体并发症发生率（30.0%对30.4%；P = 0.8）、死亡率（1.7%对0%；P = 1.0）以及静脉镇痛需求（3.0天对2.1天；P = 0.21）方面，差异均无统计学意义。机器人辅助组的术后肠梗阻持续时间显著更短（2.2天对2.8天；P = 0.01）。对于单纯性、复杂性或复发性憩室病，机器人辅助乙状结肠切除术是一种安全可行的手术方式。然而，与腹腔镜切除术相比，机器人辅助乙状结肠切除术除了术后肠梗阻持续时间略短外，对患者并无相关临床益处。
