Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique-Hôpitaux de Paris, 157 rue de la Porte de Trivaux, 92141, Clamart cedex, France.
Paris-Saclay University, 91405, Orsay, France.
J Robot Surg. 2021 Dec;15(6):891-898. doi: 10.1007/s11701-020-01181-5. Epub 2021 Jan 23.
Benefits of robotic surgery for Roux-en-Y gastric bypass (RYGB) are still debated. We aimed to compare conventional laparoscopic (L-RYGB) to robotic RYGB (R-RYGB) and evaluate safety, efficacy, advantages and drawbacks of each procedure. A prospective cohort study with a retrospective review approach was conducted to analyze results of L-RYGB and R-RYGB performed at a bariatric center of excellence. Patient demographics, perioperative data, weight loss, comorbidities evolution and cost were assessed. One hundred and sixty-one severely obese patients underwent R-RYGB and L-RYGB, respectively. Patient's characteristics were similar between groups. Intraoperative blood loss was similar (p = 0.91), with no requirement for blood transfusion. Median operative time was significantly reduced for R-RYGB (127 vs 160 min; p < 0.001). Seven patients (11.4%) in the L-RYGB group and 15 patients (15%) in the R-RYGB group had early postoperative complications (p = 0.63), with more anastomotic leaks and stenosis for R-RYGB during initial learning curve (p = NS). Mortality was null. Median length of hospital stay was similar (6 days; p = 0.20). Mean hospital cost was non-significantly increased for R-RYGB ($5730 vs. $4879; p = 0.34). Two years after surgery, median BMI and mean EWL% were similar for both groups (26.1 vs 26.5 kg/m and 89.9% vs 90.9% for L-RYGB and R-RYGB groups, respectively; p = 0.71 and 0.85, respectively), with no statistically significant difference in comorbidities between the two groups (p = 0.80). R-RYGB is feasible and safe within the reach of every laparoscopic surgeon. In our series, it was associated with shorter operative time and equivalent length of stay and weight loss outcomes compared to L-RYGB. Further well-designed randomized studies are necessary to draw safe conclusions.
机器人辅助胃旁路手术（RYGB）的益处仍存在争议。我们旨在比较传统腹腔镜（L-RYGB）和机器人 RYGB（R-RYGB），并评估每种手术的安全性、疗效、优点和缺点。一项前瞻性队列研究采用回顾性研究方法，分析了在一家减重卓越中心进行的 L-RYGB 和 R-RYGB 的结果。评估了患者人口统计学、围手术期数据、减重、合并症演变和成本。161 名严重肥胖患者分别接受了 R-RYGB 和 L-RYGB。两组患者的特征相似。术中出血量相似（p=0.91），无需输血。R-RYGB 的中位手术时间明显缩短（127 分钟 vs. 160 分钟；p<0.001）。L-RYGB 组有 7 名（11.4%）患者和 R-RYGB 组有 15 名（15%）患者发生早期术后并发症（p=0.63），在初始学习曲线期间 R-RYGB 有更多的吻合口漏和狭窄（p=NS）。无死亡病例。中位住院时间相似（6 天；p=0.20）。R-RYGB 的平均住院费用略有增加（5730 美元 vs. 4879 美元；p=0.34）。手术后 2 年，两组的 BMI 中位数和 EWL%平均值相似（26.1 公斤/米和 26.5 公斤/米和 89.9%和 90.9%分别为 L-RYGB 和 R-RYGB 组；p=0.71 和 0.85），两组之间的合并症无统计学差异（p=0.80）。R-RYGB 对每位腹腔镜外科医生来说都是可行和安全的。在我们的系列中，与 L-RYGB 相比，它具有更短的手术时间、相似的住院时间和减重效果。需要进一步进行设计良好的随机研究，以得出安全结论。
