University Health Systems, University of Tennessee Medical Center, 1934 Alcoa Highway, Suite D-285, Knoxville, TN, 37920, USA.
Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
Surg Endosc. 2021 Mar;35(3):1331-1341. doi: 10.1007/s00464-020-07511-w. Epub 2020 Mar 31.
Ventral hernia repair (VHR) is a commonly performed procedure and is especially prevalent in patients who have undergone previous open abdominal surgery: up to 28% of patients who have undergone laparotomy will develop a ventral hernia. There is increasing interest in robotic-assisted VHR (RVHR) as a minimally invasive approach to VHR not requiring myofascial release and in RVHR outcomes relative to outcomes associated with laparoscopic VHR (LVHR). We hypothesized real-world evidence from the Americas Hernia Society Quality Collaborative (AHSQC) database will indicate comparable clinical outcomes from RVHR and LVHR approaches not employing myofascial release.
Retrospective, comparative analysis of prospectively collected data describing laparoscopic and robotic-assisted elective ventral hernia repair procedures reported in the multi-institutional AHSQC database. A one-to-one propensity score matching algorithm identified comparable groups of patients to adjust for potential selection bias that could result from surgeon choice of repair approach.
Matched data describe preoperative characteristics and perioperative outcomes in 615 patients in each group. The following significant differences were observed among the 11 outcomes that were pre-specified. Operative time tended to be longer for the RVHR group compared to the LVHR group (p < 0.001). Length of stay differed between the two groups; while both groups had a median length of stay of 0, stay lengths tended to be longer in the LVHR group (p < 0.001). Rates of conversion to laparotomy were fewer for the RVHR group: < 1% and 2%, respectively (p = 0.007). Through 30 days, there were fewer RVHR patient-clinic visits (p = 0.038).
Both RVHR and LVHR perioperative results compare favorably with each other in most measures. Differences favored RVHR in terms of shorter LOS, fewer conversions to laparotomy, and fewer postoperative clinic visits; differences favored LVHR in terms of shorter operative times.
腹壁疝修补术（VHR）是一种常见的手术，尤其在接受过开腹手术的患者中更为常见：多达 28%的剖腹手术患者会出现腹壁疝。机器人辅助 VHR（RVHR）作为一种微创方法治疗腹壁疝越来越受到关注，这种方法不需要进行筋膜松解，并且与腹腔镜 VHR（LVHR）相关的结果相比，具有更好的效果。我们假设，来自美洲疝学会质量协作组（AHSQC）数据库的真实世界证据将表明，不进行筋膜松解的 RVHR 和 LVHR 方法具有相似的临床效果。
回顾性分析前瞻性收集的描述腹腔镜和机器人辅助择期腹壁疝修补术的数据，这些数据来自多机构 AHSQC 数据库。使用一对一倾向评分匹配算法确定可比的患者组，以调整可能因外科医生选择修复方法而导致的潜在选择偏倚。
匹配数据描述了每组 615 例患者的术前特征和围手术期结果。在预先指定的 11 个结果中观察到以下显著差异。与 LVHR 组相比，RVHR 组的手术时间往往更长（p<0.001）。两组的住院时间不同；虽然两组的中位住院时间均为 0，但 LVHR 组的住院时间往往更长（p<0.001）。RVHR 组中转开腹的比例较低：分别为<1%和 2%（p=0.007）。在 30 天内，RVHR 患者就诊次数较少（p=0.038）。
在大多数方面，RVHR 和 LVHR 的围手术期结果相互比较都有优势。在 LOS 较短、中转开腹率较低和术后就诊次数较少方面，RVHR 具有优势；在手术时间较短方面，LVHR 具有优势。
