Unit of digestive, hepatobiliary and pancreatic surgery, CARE department, Henri Mondor university hospital (AP-HP), and faculty of medicine, university of Paris Est, UPEC, Creteil, France.
Department of digestive and oncologic surgery, Ambroise Paré hospital, AP-HP, UFR Simone Veil Santé, université de Versailles Saint-Quentin-en-Yvellines/Paris Saclay university, Boulogne-Billancourt, France.
J Visc Surg. 2022 Jun;159(3):212-221. doi: 10.1016/j.jviscsurg.2022.04.001. Epub 2022 May 20.
Twenty-seven experts under the aegis of the French Association of Surgery (AFC) offer this reference system with formalized recommendations concerning the performance of right colectomy by robotic approach (RRC). For RRC, experts suggest patient installation in the so-called "classic" or "suprapubic" setup. For patients undergoing right colectomy for a benign pathology or cancer, RRC provides no significant benefit in terms of intra-operative blood loss, intra-operative complications or conversion rate to laparotomy compared to laparoscopy. At the same time, RRC is associated with significantly longer operating times. Data from the literature are insufficient to define whether the robot facilitates the performance of an intra-abdominal anastomosis, but the robotic approach is more frequently associated with an intra-abdominal anastomosis than the laparoscopic approach. Experts also suggest that RRC offers a benefit in terms of post-operative morbidity compared to right colectomy by laparotomy. No benefit is retained in terms of mortality, duration of hospital stay, histological results, overall survival or disease-free survival in RRC performed for cancer. In addition, RRC should not be performed based on the cost/benefit ratio, since RRC is associated with significantly higher costs than laparoscopy and laparotomy. Future research in the field of RRC should consider the evaluation of patient-targeted parameters such as pain or quality of life and the technical advantages of the robot for complex procedural steps, as well as surgical and oncological results.
二十七位法国外科协会（AFC）的专家提出了这个参考系统，并对机器人右结肠切除术（RRC）的操作提出了正式建议。对于 RRC，专家建议患者采用所谓的“经典”或“耻骨上”体位。对于因良性病变或癌症而接受右结肠切除术的患者，与腹腔镜手术相比，RRC 在术中出血量、术中并发症或中转开腹率方面没有显著优势。同时，RRC 与手术时间明显延长有关。文献中的数据不足以确定机器人是否有助于进行腹腔内吻合，但机器人方法与腹腔镜方法相比，更常与腹腔内吻合相关。专家还建议，与开腹右结肠切除术相比，RRC 术后发病率方面具有优势。对于因癌症而进行的 RRC，在死亡率、住院时间、组织学结果、总生存率或无病生存率方面没有保留任何优势。此外，不应根据成本效益比来进行 RRC，因为与腹腔镜手术和开腹手术相比，RRC 的成本明显更高。RRC 领域的未来研究应考虑评估患者为导向的参数，如疼痛或生活质量，以及机器人在复杂手术步骤中的技术优势，以及手术和肿瘤学结果。
