Department of Surgery, Division of Colon and Rectal Surgery, New York University Langone Health, 530 First Ave Suite 7V, New York, NY, 10016, USA.
J Robot Surg. 2021 Jun;15(3):465-472. doi: 10.1007/s11701-020-01125-z. Epub 2020 Jul 28.
The robotic platform can overcome limitations of the laparoscopic approach, particularly in the facilitation of intracorporeal anastomosis creation. We aim to share our institutional experience with robotic ileocolic resection for Crohn's disease (CD) and compare it to a laparoscopic cohort. We identified patients who underwent ileocolic resection for CD with a purely robotic (R) or laparoscopic (L) approach between February 2015 and 2018. Chart review was performed and preoperative, intraoperative, and postoperative data was collected. A total of 47 patients with a mean age of 35.2 years old were identified and 61% were female. Seventy percent [n = 33, (23 females, 69.6%)] of the cases were performed robotically and 30% of the cases [n = 14, (6 females, 42.8%)] were performed laparoscopically. The groups were well matched for age, gender, BMI as well as disease related factors (CD duration; clinical classification and location), perioperative immunosuppression, and surgical history. Time to bowel function was shorter by about 1 day in the robotic group (R: 1.9 ± 0.88 days vs. L: 2.7 ± 0.8 days, p = 0.003). Mean operative time was longer in the robotic group by 51 min and this difference was significant (p = 0.03), however 30.3% of patients underwent ureteral stent placement, which can account for added time in robotic cases. There were less conversions in the robotic group [R: 1(4.3%) vs. L: 1(7%)], but this was not significant. There were no intraoperative complications in either group. Complication (L: 21.4% vs. R: 15.1%, p = 0.605) and reoperation rates (L: 0% vs. R: 3.03%, p = 0.429) were similar. Robotic ileocolic resection for Crohn's disease is as safe and feasible as the laparoscopic approach. This was accomplished with no leaks, major morbidity or mortality and comparable length of stay, with 1 day shorter return of bowel function, and with a lower overall complication rate. The robotic approach offers advantages in Crohn's disease which should be studied further in prospective studies.
机器人平台可以克服腹腔镜方法的局限性，特别是在促进体内吻合口创建方面。我们旨在分享我们机构在机器人回肠结肠切除术治疗克罗恩病（CD）方面的经验，并将其与腹腔镜队列进行比较。我们确定了 2015 年 2 月至 2018 年间接受单纯机器人（R）或腹腔镜（L）方法回肠结肠切除术治疗 CD 的患者。进行了病历回顾，并收集了术前、术中、术后数据。共确定了 47 名平均年龄为 35.2 岁的患者，其中 61%为女性。70%[n=33，（23 名女性，占 69.6%）]的病例采用机器人方法进行，30%的病例[n=14，（6 名女性，占 42.8%）]采用腹腔镜方法进行。两组在年龄、性别、BMI 以及疾病相关因素（CD 持续时间；临床分类和位置）、围手术期免疫抑制和手术史方面匹配良好。机器人组的肠道功能恢复时间缩短了约 1 天（R：1.9±0.88 天 vs. L：2.7±0.8 天，p=0.003）。机器人组的平均手术时间延长了 51 分钟，这一差异具有统计学意义（p=0.03），但 30.3%的患者需要放置输尿管支架，这可能导致机器人手术时间延长。机器人组的转换率较低[R：1（4.3%）vs. L：1（7%）]，但无统计学意义。两组均无术中并发症。并发症（L：21.4% vs. R：15.1%，p=0.605）和再次手术率（L：0% vs. R：3.03%，p=0.429）相似。机器人回肠结肠切除术治疗克罗恩病与腹腔镜方法一样安全可行。该手术无漏诊、严重发病率或死亡率，且住院时间相似，肠道功能恢复时间缩短 1 天，总并发症发生率较低。机器人方法在克罗恩病中有优势，应在进一步的前瞻性研究中进行研究。
