Department of General Surgery, Geisinger Medical Center, Danville, PA.
Department of General Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
JSLS. 2020 Oct-Dec;24(4). doi: 10.4293/JSLS.2020.00058.
Robotic inguinal hernia repair is the latest iteration of minimally invasive herniorrhaphy. Previous studies have shown expedited learning curves compared to traditional laparoscopy, which may be offset by higher cost and longer operative time. We sought to compare operative time and direct cost across the evolving surgical practice of 10 surgeons in our healthcare system.
This is a retrospective review of all transabdominal preperitoneal robotic inguinal hernia repairs performed by 10 general surgeons from July 2015 to September 2018. Patients requiring conversion to an open procedure or undergoing simultaneous procedures were excluded. The data was divided to compare each surgeon's initial 20 cases to their subsequent cases. Direct operative cost was calculated based on the sum of supplies used intra-operatively. Multivariate analysis, using a generalized estimating equation, was adjusted for laterality and resident involvement to evaluate outcomes.
Robotic inguinal hernia repairs were divided into two groups: early experience (n = 167) and late experience (n = 262). The late experience had a shorter mean operative time by 17.6 min (confidence interval: 4.06 - 31.13, p = 0.011), a lower mean direct operative cost by $538.17 (confidence interval: 307.14 - 769.20, p < 0.0001), and fewer postoperative complications (p = 0.030) on multivariate analysis. Thirty-day readmission rates were similar between both groups.
Increasing surgeon experience with robotic inguinal hernia repair is associated with a predictable reduction in operative time, complication rates, and direct operative cost per case. Thirty-day readmission rates are not affected by the learning curve.
机器人腹股沟疝修补术是微创疝修补术的最新迭代。先前的研究表明，与传统腹腔镜相比，它的学习曲线更快，但其成本更高，手术时间更长。我们试图比较我们医疗系统中 10 位外科医生不断发展的手术实践中的手术时间和直接成本。
这是对 2015 年 7 月至 2018 年 9 月期间 10 位普外科医生进行的所有经腹腹膜前机器人腹股沟疝修补术的回顾性研究。排除需要转为开放手术或同时进行手术的患者。根据术中使用的耗材总和计算直接手术成本。使用广义估计方程进行多变量分析，调整了侧别和住院医师参与情况，以评估结果。
机器人腹股沟疝修补术分为两组：早期经验（n = 167）和晚期经验（n = 262）。晚期经验的平均手术时间缩短了 17.6 分钟（置信区间：4.06-31.13，p = 0.011），平均直接手术成本降低了 538.17 美元（置信区间：307.14-769.20，p < 0.0001），并且术后并发症更少（p = 0.030）。多变量分析显示，两组 30 天再入院率相似。
外科医生在机器人腹股沟疝修补术方面的经验不断增加，与手术时间、并发症发生率和每例手术的直接手术成本的可预测降低相关。学习曲线不会影响 30 天再入院率。
