Abdel Jalil Salah, Abdel Jalil Ala' Abdel, Groening Rachel, Biswas Saptarshi
General Surgery, Grand Strand Medical Center, Myrtle Beach, USA.
Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA.
Cureus. 2021 Nov 18;13(11):e19698. doi: 10.7759/cureus.19698. eCollection 2021 Nov.
Laparoscopy-assisted surgery (LAS) for colorectal cancer (CRC) was first described in 1991 and robotic-assisted surgery (RAS) for CRC was first reported in 2002; robotic-assisted colorectal surgery (RACS) is becoming increasingly popular. However, data comparing its outcomes to other established techniques remain limited to small case series. Our primary goal was to review the mortality outcome difference between laparoscopic versus robotic elective colon resection at a small, community hospital.
We conducted a retrospective review of 2089 patients at the South Atlantic division for cases who underwent robotic and laparoscopic colectomies at our division in 2014-2018. All cases were elective surgeries and analysis was performed within these two subgroups.
In this study, 306 patients underwent robotic colorectal surgery versus 1783 patients who underwent laparoscopic-assisted colorectal surgery. Readmission rate within 30 days of operation was significantly lower for laparoscopic-assisted colorectal resection (LACR) versus RACS (445.4% vs. 53.9%, p= 0.006). However, the length of hospital stay was significantly shorter for RACS with a median of three days (interquartile range {IQR}: 2-5) versus four days (IQR: 3-7) for LACR (p=0.0001). There were no significant differences between the two groups for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, or rate of conversion to an open procedure.
Our study showed a similar outcome between LACR and RACS for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, and rate of conversion to an open procedure. Also, our study showed a readmission rate within 30 days of operation was significantly lower for LACR versus RACS. However, the length of hospital stay was significantly shorter for RACS with a median of three days when compared to LACR. Future research should focus on surgeon-specific variables, such as comfort, ergonomics, distractibility, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.
1991年首次描述了腹腔镜辅助手术（LAS）用于结直肠癌（CRC）的治疗，2002年首次报道了机器人辅助手术（RAS）用于CRC的治疗；机器人辅助结直肠手术（RACS）正变得越来越流行。然而，将其结果与其他成熟技术进行比较的数据仍仅限于小病例系列。我们的主要目标是在一家小型社区医院回顾腹腔镜与机器人选择性结肠切除术之间的死亡率结果差异。
我们对南大西洋分部2089例患者进行了回顾性研究，这些患者于2014年至2018年在我们分部接受了机器人和腹腔镜结肠切除术。所有病例均为择期手术，并在这两个亚组内进行分析。
在本研究中，306例患者接受了机器人结直肠手术，1783例患者接受了腹腔镜辅助结直肠手术。腹腔镜辅助结直肠切除术（LACR）术后30天内的再入院率显著低于RACS（445.4%对53.9%，p = 0.006）。然而，RACS的住院时间显著缩短，中位数为3天（四分位间距{IQR}：2 - 5），而LACR为4天（IQR：3 - 7）（p = 0.0001）。两组在术后切口疝、吻合口漏、术后疼痛控制、手术部位感染或转为开放手术的发生率方面无显著差异。
我们的研究表明，LACR和RACS在术后切口疝、吻合口漏、术后疼痛控制、手术部位感染以及转为开放手术的发生率方面结果相似。此外，我们的研究表明，LACR术后30天内的再入院率显著低于RACS。然而，与LACR相比，RACS的住院时间显著缩短，中位数为3天。未来的研究应关注特定于外科医生的变量，如舒适度、人体工程学、注意力分散度和易用性，作为可能区分机器人与腹腔镜结直肠手术的其他方法。
