Department of Surgery, Division of Colon and Rectal Surgery, John and Rebecca Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr. #0987, La Jolla, CA, 92037, USA.
University of California School of Medicine, San Diego, CA, USA.
Surg Endosc. 2020 Nov;34(11):5153-5159. doi: 10.1007/s00464-020-07633-1. Epub 2020 Sep 9.
Common colorectal procedures that require access to all quadrants of the abdomen are subtotal colectomy (STC) and total proctocolectomy (TPC). These are frequently performed with a surgical robot, but multiquadrant operations have unique challenges during robot-assisted surgery.
Patients who underwent robotic STC or TPC with the da Vinci Xi surgical robot at our institution from July 1, 2016 through June 30, 2019 were identified by diagnosis and procedure codes. A technical description is provided for the techniques utilized at our institution. Outcomes included operative times (OT), supply cost and length of stay. Associated morbidity and mortality was also analyzed.
From a review of our institution's robotic surgery data, 37 cases were identified that utilized the described technique. Of these cases, 21 were robotic STC and 16 were TPC. Total mean OT was 276.86 min (SD ± 119.49). Mean OT was further analyzed by year, which demonstrated an overall decrease in OT from 350.91 min (SD ± 46.38) in 2016 to 221.43 min (SD ± 16.46) in 2018 (p = 0.008). A total of 21 cases were performed prior to 2018. Overall OT for STC was 222.81 min (SD ± 14.54) compared to overall TPC OT 347.81 min (SD ± 34.35). Median length of stay was 5 days [25th and 75th percentiles 4, 6, respectively]. There was no 30-day mortality and only one return to operating room for mesenteric bleeding. There was a low risk of mortality associated with this technique.
The current study provides the largest cohort of patients assessed who have undergone multiquadrant robotic STC or TPC. The study provides a detailed description of the technique utilized at our institution. There was no associated 30-day mortality and a low risk of morbidity. The data suggest that the learning curve for improved operative time is between 15 and 20 cases.
需要进入腹部所有象限的常见结直肠手术包括次全结肠切除术（STC）和全直肠结肠切除术（TPC）。这些手术通常使用手术机器人完成，但机器人辅助手术中多象限操作具有独特的挑战。
通过诊断和手术程序代码，确定 2016 年 7 月 1 日至 2019 年 6 月 30 日期间在我院接受达芬奇 Xi 手术机器人进行 STC 或 TPC 的患者。提供了我们机构使用的技术的技术描述。结果包括手术时间（OT）、供应成本和住院时间。还分析了相关发病率和死亡率。
通过审查我院的机器人手术数据，确定了 37 例使用描述技术的病例。其中 21 例为机器人 STC，16 例为 TPC。总平均 OT 为 276.86 分钟（SD±119.49）。按年份进一步分析平均 OT，结果显示 OT 总体减少，从 2016 年的 350.91 分钟（SD±46.38）减少到 2018 年的 221.43 分钟（SD±16.46）（p=0.008）。共有 21 例在 2018 年之前进行。STC 的总 OT 为 222.81 分钟（SD±14.54），而 TPC 的总 OT 为 347.81 分钟（SD±34.35）。中位住院时间为 5 天[第 25 和第 75 个百分位数分别为 4、6]。没有 30 天死亡率，只有一例因肠系膜出血返回手术室。该技术与低死亡率相关。
本研究提供了评估多象限机器人 STC 或 TPC 的最大患者队列。该研究详细描述了我们机构使用的技术。没有 30 天死亡率和低发病率。数据表明，手术时间的学习曲线在 15 到 20 例之间。
