Aziz Hassan, Zeeshan Muhammad, Kaur Navpreet, Emamaullee Juliet, Ahearn Aaron, Kulkarni Sujit, Genyk Yuri, Selby Robert R, Sheikh Mohd Raashid
From the *Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California and.
†Department of Surgery, Westchester Medical Center, Valhalla, New York.
Am Surg. 2020 Apr 1;86(4):341-345.
Robotic surgery has been widely adopted by many specialties, including hepatobiliary surgery. However, robotic procedures generally require longer operative times and are costlier than their laparoscopic counterparts. The role for robotic cholecystectomy (RC), particularly in patients with advanced liver disease, has not been established. A retrospective analysis of the NSQIP database was performed, focusing on patients with chronic liver disease who underwent cholecystectomy. Patients were categorized based on their model for end-stage liver disease (MELD) score and the type of surgical procedure: open, laparoscopic, or RC. Rates of a variety of postoperative complications including length of stay (LOS) were analyzed. In patients with a MELD score of 21 to 30, open cholecystectomy was associated with a long hospital LOS (3 1 1; -0.01). RC was equivalent to laparoscopic cholecystectomy in terms of perioperative mortality for higher MELD score patients but was associated with lower conversion rates and overall LOS. This data suggests that RC should be considered in patients with advanced liver disease needing cholecystectomy.
机器人手术已被包括肝胆外科在内的许多专科广泛采用。然而，机器人手术通常需要更长的手术时间，且比腹腔镜手术成本更高。机器人胆囊切除术（RC）的作用，尤其是在晚期肝病患者中的作用尚未明确。我们对国家外科质量改进计划（NSQIP）数据库进行了回顾性分析，重点关注接受胆囊切除术的慢性肝病患者。根据终末期肝病模型（MELD）评分和手术方式（开放手术、腹腔镜手术或RC）对患者进行分类。分析了包括住院时间（LOS）在内的各种术后并发症发生率。在MELD评分为21至30的患者中，开放胆囊切除术与较长的住院时间相关（3±1；P=-0.01）。对于MELD评分较高的患者，RC在围手术期死亡率方面与腹腔镜胆囊切除术相当，但转换率和总体住院时间较低。这些数据表明，对于需要进行胆囊切除术的晚期肝病患者，应考虑采用RC。
