Adipositas- und metabolische Chirurgie, Klinik für Allgemein-, Viszeral und Thoraxchirurgie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
J Robot Surg. 2022 Feb;16(1):235-239. doi: 10.1007/s11701-021-01212-9. Epub 2021 Apr 1.
The rise of robotic assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This in particular is of great advantage not only in primary cases, but also in patients undergoing revisional procedures following preceding upper GI surgery. In the following, our experience with intraoperative conversions and complications in revisional robotic surgery using the Da Vinci robotic system will be reported and compared to primary robotic bypass surgery and the literature. In a 36-month period, a total of 157 minimally invasive bariatric procedures (48 robotic assisted, 109 laparoscopic) were performed. Out of 43 patients receiving a gastric bypass 32 (74%) were performed robotically. Out of these 20 (62.5%) had previous operations (RRBP): one hiatal mesh repair, one open Mason operation, eight gastric band, nine gastric sleeve, one sleeve with fundoplication. The Da Vinci Xi was used for all surgeries. 3/20 (15%) RRBP were converted to open laparotomy because of a huge left liver lobe (1), extreme adhesions (1) and short mesentery (1) (p = 0.631 vs 1/12 RBP). One out of these had to be reoperated for an insufficiency of the gastroenterostomy. 3/17 (23%) patients (RRBP) without conversion had complications: hemorrhage (1), insufficiency of biliodigestive anastomosis (1), insufficiency of gastroenterostomy (1). There was no mortality and length of hospital stay was 3.5 days in uncomplicated cases and 12.3 days in complicated cases (p < 0.05). This preliminary experience suggests, that robotic revisional surgery can be performed safely even in complicated cases. Conversion to laparoscopic or open surgery may be required when adverse anatomical conditions are present. However, the incidence of complications was not increased when conversion was performed. In this series, the incidence of complications was not greater in case of revisional surgery.
机器人辅助手术在病态肥胖患者治疗中的兴起，扩大了参与减重手术的外科医生的治疗手段。这不仅在初次手术中非常有利，而且在先前接受过上消化道手术的患者进行翻修手术时也非常有利。在下面，我们将报告并比较达芬奇机器人系统在翻修机器人手术中的术中转换和并发症的经验，并与初次机器人旁路手术和文献进行比较。在 36 个月的时间里，共进行了 157 例微创减重手术（48 例机器人辅助，109 例腹腔镜）。在接受胃旁路手术的 43 名患者中，有 32 名（74%）是机器人手术。在这些患者中，有 20 名（62.5%）有先前的手术史（RRBP）：一个食管裂孔网修复术，一个开腹 Mason 手术，八个胃带，九个胃袖，一个袖套加胃底折叠术。所有手术均使用达芬奇 Xi 机器人系统进行。由于左肝叶巨大（1 例）、极度粘连（1 例）和肠系膜短（1 例），20 例 RRBP 中有 3 例（15%）需要转换为开腹手术（p = 0.631 与 12 例 RBP 相比）。其中 1 例因胃肠吻合口不全需要再次手术。在没有转换的 17 例患者中，有 3 例（RRBP）发生并发症：出血（1 例）、胆肠吻合口不全（1 例）、胃肠吻合口不全（1 例）。无死亡病例，无并发症患者的住院时间为 3.5 天，有并发症患者的住院时间为 12.3 天（p < 0.05）。这初步的经验表明，即使在复杂的情况下，机器人翻修手术也可以安全进行。当存在不利的解剖条件时，可能需要转换为腹腔镜或开腹手术。然而，当进行转换时，并发症的发生率并没有增加。在本系列中，翻修手术的并发症发生率并没有增加。
