Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
Department of Abdominal Surgery, Hospital Oost-Limburg, Genk, Belgium.
J Robot Surg. 2023 Feb;17(1):79-88. doi: 10.1007/s11701-022-01405-w. Epub 2022 Mar 24.
The reproducibility of the implementation of robotic liver surgery (RLS) is still debated. The aim of the present study is to evaluate short-term outcomes and cost differences during the implementation of RLS, performed by an early adopter in laparoscopic liver surgery (LLS). Patients undergoing RLS between February 2020 and May 2021 were included. Short-term outcomes of the robotic group (RG) were compared to the "Initial Phase" group (IP) of 120 LLS cases and the 120 most recent laparoscopic cases or "Mastery Phase" group (MP). A cost analysis per procedure for the three groups was performed. Seventy-one patients underwent RLS during the study period. Median operative time in the RG was comparable to the IP, but significantly shorter in the MP (140 vs 138 vs 120 min, p < 0.001). Median intraoperative blood loss in the RG was lower than in both laparoscopic groups (40 ml [20-90 ml] vs 150 ml [50-250 ml] vs 80 ml [30-150 ml], p < 0.001). Median hospital stay in the RG was significantly shorter than the IP group (p < 0.001). There were no significant differences in postoperative complication, conversion, or readmission rates. Procedural cost analysis was in favor of robotic surgery (€5008) compared to the IP (€ 6913) and the MP (€6099). Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. The total average cost per procedure is lower for RLS compared to LLS.
机器人肝手术（RLS）实施的可重复性仍存在争议。本研究旨在评估腹腔镜肝手术（LLS）早期采用者实施 RLS 的短期结果和成本差异。纳入 2020 年 2 月至 2021 年 5 月期间接受 RLS 的患者。将机器人组（RG）的短期结果与 120 例 LLS 病例的“初始阶段”组（IP）和最近的 120 例腹腔镜病例或“掌握阶段”组（MP）进行比较。对三组每例手术的成本进行了分析。研究期间，71 例患者接受了 RLS。RG 的中位手术时间与 IP 相当，但在 MP 中显著缩短（140 对 138 对 120 分钟，p < 0.001）。RG 术中失血量中位数低于两组腹腔镜手术（40 毫升[20-90 毫升]对 150 毫升[50-250 毫升]对 80 毫升[30-150 毫升]，p < 0.001）。RG 的中位住院时间明显短于 IP 组（p < 0.001）。术后并发症、中转和再入院率无显著差异。手术成本分析有利于机器人手术（€5008）与 IP（€6913）和 MP（€6099）相比。具有足够 LLS 经验的外科医生可以迅速克服 RLS 的学习曲线。根据我们的经验，RLS 实施阶段的短期结果与 LLS 的掌握阶段相似。与 LLS 相比，每例手术的总成本平均较低。
