Department of General Surgery, University of Missouri-Kansas City, Kansas City, MO, USA.
St. Luke's Hospital on the Plaza, Kansas City, MO, USA.
Sci Rep. 2021 Apr 13;11(1):8086. doi: 10.1038/s41598-021-86093-6.
The surgical complexities of our current population have pushed the technological limits of healthcare, urging for minimally invasive approaches. For ventral hernias, in particular, robotic assisted laparoscopic repairs have been met with conflict. Cost and longer operative times are among the arguments against robotic surgery, although thorough evaluation of patient outcomes could potentially advocate for use of this tool. We attempted to approach this by retrospectively reviewing our own data. We reviewed charts between September 2016 and February 2017 of patients receiving complex hernia repairs, either a standard open repair (SOR) or robotic-assisted repair (RAR). Data collected included preoperative, perioperative, and postoperative care. Of the 43 patients reviewed, 16 were SOR, versus 27 RAR. Patients were comparable in age, gender, BMI, diabetes as a comorbidity; average hernia defect size was similar between the two groups. Although operative times were longer in the RAR group, estimated blood loss (EBL) was less. Hospital stay was also shorter in the RAR group, at 3.0 ± 1.9 days versus 9.6 ± 8.4 days for the OAR group. Of those requiring critical care management, only one patient had a robotic assisted repair, versus half of the patients who received an open repair. Of the patients who presented to the emergency department within 30 days of surgery, each group had four patients, and two from the OAR group required admission. Our data is consistent with other literature supporting shorter lengths of stays. Although the robotic approach did required a longer operative time, the resulting improved patient outcomes support this technique for complex ventral hernia repairs.
我们当前的人口所具有的外科复杂性已经推动了医疗技术的极限发展，迫切需要采用微创方法。对于腹疝，特别是机器人辅助腹腔镜修复术存在争议。成本和更长的手术时间是反对机器人手术的论据之一，尽管对患者结果的彻底评估可能会支持使用这种工具。我们试图通过回顾我们自己的数据来解决这个问题。我们回顾了 2016 年 9 月至 2017 年 2 月期间接受复杂疝修复的患者的图表，这些患者接受了标准的开放式修复（SOR）或机器人辅助修复（RAR）。收集的数据包括术前、围手术期和术后护理。在 43 名接受审查的患者中，有 16 名接受了 SOR，27 名接受了 RAR。患者在年龄、性别、BMI、糖尿病合并症方面具有可比性；两组患者的平均疝缺损大小相似。虽然 RAR 组的手术时间较长，但估计失血量（EBL）较少。RAR 组的住院时间也较短，为 3.0±1.9 天，而 OAR 组为 9.6±8.4 天。需要重症监护管理的患者中，只有 1 名接受了机器人辅助修复，而接受开放式修复的患者中有一半需要。在术后 30 天内到急诊科就诊的患者中，每组有 4 名患者，OAR 组中有 2 名患者需要入院。我们的数据与其他支持较短住院时间的文献一致。尽管机器人方法确实需要更长的手术时间，但由此产生的改善的患者结果支持这种技术用于复杂的腹疝修复。
