Section of Minimally Invasive and Robotic Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA.
Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, AZ, USA.
Obes Surg. 2021 Feb;31(2):854-861. doi: 10.1007/s11695-020-05055-5. Epub 2020 Nov 9.
Robotic-assisted surgery has become increasingly popular across surgical subspecialties. We aimed to analyze trends in the national utilization and outcomes in bariatric surgery.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for 2015-2018 was queried. We included robotic-assisted sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional cases. The Kruskal-Wallis test or Wilcoxon rank-sum were used for comparing continuous variables and Cochran-Armitage trend analysis for categorical variables when comparing years, or with Fisher's Exact Test when directly comparing categories.
Of 760,076 bariatric cases performed between 2015 and 2018, 7.4% with robotic and 90.4% with laparoscopic approach. SG constituted 61.3% of robotic volume. Utilization of robotic surgery increased 1.96-fold; SG represented the most substantial increase of 2.16-fold, followed by a 1.53-fold in RYGB. The 30-day readmission and re-intervention rates decreased from 5.63% to 4.78% (p<0.01), and 2.31% to 1.46% (p<0.01), respectively. The overall leak rate improved from 0.64% to 0.39% (p=0.01). Mortality and re-operations remained statistically unchanged. When compared to laparoscopic approach, the operative time were significantly longer in the robotic group. Regarding postoperative outcomes, when adjusted for patient characteristics, there were no differences between two approaches except a higher leak rate in robotic group in 2015.
A steady increase in robotic bariatric surgery is apparent. While the operative time remains significantly longer in the robotic group, trends indicate improvement in key quality metrics and patient outcomes as utilization increases.
机器人辅助手术在各个外科专业中越来越受欢迎。我们旨在分析减重手术中全国利用率和结果的趋势。
查询了 2015-2018 年代谢和减重手术认证和质量改进计划（MBSAQIP®）的数据。我们纳入了机器人辅助袖状胃切除术（SG）、胃旁路术（RYGB）、可调胃带（AGB）、胆胰分流十二指肠转位术（BPD-DS）和修正手术。当比较年份时，使用 Kruskal-Wallis 检验或 Wilcoxon 秩和检验比较连续变量，使用 Cochran-Armitage 趋势分析比较分类变量，当直接比较类别时使用 Fisher 精确检验。
在 2015 年至 2018 年期间进行的 760,076 例减重手术中，7.4%采用机器人辅助，90.4%采用腹腔镜辅助。SG 占机器人手术量的 61.3%。机器人手术的使用率增加了 1.96 倍；SG 的使用率增加了 2.16 倍，其次是 RYGB 的 1.53 倍。30 天再入院和再干预率从 5.63%降至 4.78%（p<0.01），分别从 2.31%降至 1.46%（p<0.01）。总的漏诊率从 0.64%提高到 0.39%（p=0.01）。死亡率和再次手术保持统计学不变。与腹腔镜组相比，机器人组的手术时间明显更长。关于术后结果，在调整了患者特征后，两种方法之间除了机器人组在 2015 年漏诊率较高外，没有其他差异。
机器人减重手术的使用率稳步增加。虽然机器人组的手术时间仍然明显较长，但随着使用率的提高，趋势表明关键质量指标和患者结局有所改善。
