腹部手术粘连相关的转化。机器人与腹腔镜方法：多中心经验。
Conversions related to adhesions in abdominal surgery. Robotic versus laparoscopic approach: A multicentre experience.
机构信息
Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
Unit of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.
出版信息
Int J Med Robot. 2021 Apr;17(2):e2186. doi: 10.1002/rcs.2186. Epub 2020 Nov 16.
BACKGROUND
An advantage of robotic surgery over laparoscopy is the lower rate of unplanned conversion. One of the implicated reasons for conversion is adhesions from previous abdominal surgeries (PASs).
METHODS
A comparative analysis of 98 patients with history of open PAS treated by laparoscopic or robotic surgery was performed. Primary endpoint was the rate of conversion to open surgery related to adhesiolysis. Secondary endpoints were short-term outcomes and complications.
RESULTS
Conversion rate specifically related to adhesiolysis was significantly lower in robotic group (13 for laparoscopic group vs. 2 for robotic group; p = 0.046). Conversions occurred during adhesiolysis were significantly related to severity of adhesions expressed by peritoneal adhesion index (PAI) score (p < 0.001), number of abdominal areas involved by adhesions (p < 0.001) and severity of PAI into the target area of surgical intervention (p = 0.021).
CONCLUSIONS
Benefits of robotic surgery are more noticeable in performing procedures with increasing technical difficulties.
背景
与腹腔镜手术相比，机器人手术的优势在于较低的计划外中转率。中转的一个潜在原因是先前腹部手术（PAS）引起的粘连。
方法
对 98 例有开放 PAS 病史的患者进行了腹腔镜或机器人手术的对比分析。主要终点是与粘连松解相关的中转开腹手术率。次要终点是短期结果和并发症。
结果
机器人组粘连松解相关中转率明显较低（腹腔镜组 13 例，机器人组 2 例；p = 0.046）。粘连松解过程中转的手术与腹膜粘连指数（PAI）评分表示的粘连严重程度（p < 0.001）、粘连累及的腹部区域数量（p < 0.001）和粘连进入手术干预目标区域的严重程度（p = 0.021）显著相关。
结论
机器人手术在执行技术难度增加的手术时优势更加明显。
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