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两种不同手术机器人模型在 Roux-en-Y 胃旁路术中的临床结局比较。

A Comparison of Clinical Outcomes Between Two Different Models of Surgical Robots in Roux-en-Y Gastric Bypass.

机构信息

Research Institute against Digestive Cancer, IRCAD, Department of Surgery, Strasbourg, France.

Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain.

出版信息

J Laparoendosc Adv Surg Tech A. 2021 Sep;31(9):969-977. doi: 10.1089/lap.2021.0477. Epub 2021 Aug 17.

Abstract

For the past 20 years, robotic surgical systems have been used for the Roux-en-Y gastric bypass (RYGB). The da Vinci Surgical System (Intuitive Surgical, Inc.) has been one of the most used robotic platforms. This study aims to retrospectively compare the performance of two models of surgical robots. A retrospective comparative study was conducted from a prospective database including all patients who underwent robotic RYGB (RRYGB) from 2011 to 2020. Of a total of 277 patients included, 134 were in the RRYGB using the da Vinci S™ (RRYGB-S™) group and 143 were in the RRYGB using the da Vinci Xi™ (RRYGB-Xi™) group. The mean operative time in the RRYGB-S and RRYGB-Xi groups was 154 ± 28 and 151 ± 32 minutes, respectively ( = .510). The was no statistically significant difference in terms of intraoperative complications between the groups with regard to positive blue test, bleeding, and failure of stapler line. The readmission rate was higher in the RRGB-S group (14.1%) than in the RRYGB-Xi group (3.4%) ( = .004), and it was mainly due to major complications ( = .003) including pouch and gastrojejunostomy anastomotic leaks ( = .001). The nonsurgical complications were statistically significantly higher in the RRYGB-S group (7.4%) than in the RRYGB-Xi group (2.1%) ( < .05), as well as the surgical complications were higher in the RRYGB-S group (7.5%) than in the RRYGB-Xi group (0%) ( < .001). The mean percentage of the total weight loss at 1 and 2 years of follow-up did not show any statistically significant difference ( = .547). The higher complication rate in the S surgical system might be correlated with the initial learning curve and stressed the need for proper robotic surgical training and accurate strategies when introducing emerging technologies into the surgical practice.

摘要

在过去的 20 年中,机器人手术系统已被用于 Roux-en-Y 胃旁路术(RYGB)。达芬奇手术系统(直觉外科公司)是使用最广泛的机器人平台之一。本研究旨在回顾性比较两种手术机器人模型的性能。

从 2011 年至 2020 年,对包括所有接受机器人 RYGB(RRYGB)的患者的前瞻性数据库进行了回顾性比较研究。共纳入 277 例患者,其中 134 例接受达芬奇 S™(RRYGB-S™)组,143 例接受达芬奇 Xi™(RRYGB-Xi™)组。RRYGB-S 和 RRYGB-Xi 组的平均手术时间分别为 154±28 和 151±32 分钟( = .510)。两组之间在术中并发症方面,阳性蓝测试、出血和吻合器线失败无统计学差异。RRYGB-S 组的再入院率(14.1%)高于 RRYGB-Xi 组(3.4%)( = .004),这主要是由于重大并发症( = .003)包括袋和胃空肠吻合口漏( = .001)。RRYGB-S 组的非手术并发症发生率(7.4%)明显高于 RRYGB-Xi 组(2.1%)( < .05),手术并发症发生率也高于 RRYGB-Xi 组(7.5%)( < .001)。1 年和 2 年随访时的总体重减轻百分比无统计学差异( = .547)。S 手术系统的较高并发症发生率可能与初始学习曲线有关,并强调在将新技术引入手术实践时需要进行适当的机器人手术培训和准确的策略。

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