Division of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Obes Surg. 2021 Jun;31(6):2583-2589. doi: 10.1007/s11695-021-05272-6. Epub 2021 Mar 1.
Revisional bariatric surgery (RBS) is becoming more common, with an estimated increase of more than 300% from 2017 to 2018. For these complex procedures, the role of robotics is still debated. The purpose of our study is to report the safety and effectiveness of robotic-assisted RBSs.
A retrospective review of electronic medical records was conducted for robotic-assisted RBSs performed at the Mayo Clinic in Florida, between January 1, 2016, and January 1, 2020. Peri- and postoperative data were analyzed, reviewing patient characteristics, indications for surgery, and outcomes.
From 160 RBSs performed during the study period, 67 were robotic-assisted and met inclusion criteria. Primary procedures included sleeve gastrectomy (26 [38.8%]), adjustable gastric band (24 [35.8%]), Roux-en-Y gastric bypass (14 [20.9%]), vertical-banded gastroplasty (2 [3.0%]), and duodenal switch (1 [1.5%]). RBSs performed were Roux-en-Y gastric bypass (49 [73.1%]), redo gastrojejunostomy (14 [20.9%]), and duodenal switch (4 [6.0%]). Rate of conversion to open procedure and rate of readmission 1 month after surgery were 6.0% and 7.5%, respectively. Rate of 30-day Clavien-Dindo grade III or higher adverse events was 4.5%. No anastomotic leaks were documented. Fifty-two patients presented with preoperative symptoms, and 69.2% reported improvement after RBS. Mean (SD) excess weight loss was 57.62% (23.80) 12 months after RBS.
Robotic-assisted RBSs are safe with low major adverse event rates. Symptom resolution and weight loss outcomes are acceptable.
减肥手术翻修术（RBS）越来越常见，据估计，2017 年至 2018 年，这一数字增加了 300%以上。对于这些复杂的手术，机器人的作用仍存在争议。本研究的目的是报告机器人辅助 RBS 的安全性和有效性。
对 2016 年 1 月 1 日至 2020 年 1 月 1 日期间在佛罗里达州梅奥诊所进行的机器人辅助 RBS 进行了回顾性电子病历审查。分析了围手术期和术后数据，回顾了患者特征、手术适应证和结果。
在研究期间进行的 160 例 RBS 中，有 67 例符合机器人辅助 RBS 纳入标准。主要手术包括袖状胃切除术（26 例[38.8%]）、可调胃束带（24 例[35.8%]）、Roux-en-Y 胃旁路术（14 例[20.9%]）、垂直带胃成形术（2 例[3.0%]）和十二指肠转位术（1 例[1.5%]）。RBS 为 Roux-en-Y 胃旁路术（49 例[73.1%]）、再行胃空肠吻合术（14 例[20.9%]）和十二指肠转位术（4 例[6.0%]）。转为开放性手术的比率和术后 1 个月再次入院的比率分别为 6.0%和 7.5%。30 天 Clavien-Dindo 分级 III 或更高不良事件的发生率为 4.5%。没有吻合口漏的记录。52 例患者术前有症状，69.2%在 RBS 后症状改善。RBS 后 12 个月的平均（SD）超重减轻率为 57.62%（23.80）。
机器人辅助 RBS 安全，主要不良事件发生率低。症状缓解和体重减轻的结果是可以接受的。
