Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California; National Clinician Scholars Program, University of California, Los Angeles, California.
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
J Surg Res. 2022 Nov;279:330-337. doi: 10.1016/j.jss.2022.06.032. Epub 2022 Jul 8.
The use of the robot in general surgery has exploded in the last decade. The Veterans Health Administration presents a unique opportunity to study differences between surgical approaches due to the ability to control for health system and insurance variability. This study compares clinical outcomes between robot-assisted and laparoscopic or open techniques for three general surgery procedures.
A retrospective observational study using the Veterans Affair Surgical Quality Improvement Program database. Operative time, length of stay, and complications were compared for cholecystectomy (robot-assisted versus laparoscopic), ventral, and inguinal hernia repair (robot-assisted versus laparoscopic or open) from 2015 to 2019.
More than 80,000 cases were analyzed (21,652 cholecystectomy, 9214 ventral hernia repairs, and 51,324 inguinal hernia repairs). Median operative time was longer for all robot-assisted approaches as compared to laparoscopic or open techniques with the largest difference seen between open and robot-assisted primary ventral hernia repair (unadjusted difference of 93 min, P < 0.001). Median length of stay was between 1 and 4 d and significantly for robot-assisted ventral hernia repairs (versus open, P < 0.01; versus lap for recurrent hernia, P < 0.05). Specific postoperative outcomes of interest were overall low with few differences between techniques.
While the robotic platform was associated with longer operative time, these findings must be interpreted in the context of a learning curve and indications for use (i.e., use of the robot for technically challenging cases). Our findings suggest that at the Veterans Health Administration, the robot is as safe a platform for common general surgery procedures as traditional approaches. Future studies should focus on patient-centered outcomes including pain and cosmesis.
在过去的十年中，机器人在普通外科中的应用呈爆炸式增长。退伍军人事务部（Veterans Health Administration）提供了一个独特的机会，可以研究由于医疗体系和保险差异而导致的不同手术方法之间的差异。本研究比较了三种普通外科手术中机器人辅助手术与腹腔镜或开放手术的临床结果。
这是一项使用退伍军人事务部手术质量改进计划数据库的回顾性观察研究。比较了 2015 年至 2019 年期间胆囊切除术（机器人辅助与腹腔镜）、腹侧和腹股沟疝修补术（机器人辅助与腹腔镜或开放）的手术时间、住院时间和并发症。
分析了 8 万多例病例（胆囊切除术 21652 例，腹侧疝修补术 9214 例，腹股沟疝修补术 51324 例）。与腹腔镜或开放技术相比，所有机器人辅助方法的中位手术时间都更长，而开放式与机器人辅助原发性腹侧疝修补术之间的差异最大（未调整差异 93 分钟，P < 0.001）。中位住院时间为 1 至 4 天，机器人辅助腹侧疝修补术明显长于开放手术（与开放相比，P < 0.01；与腹腔镜治疗复发性疝相比，P < 0.05）。感兴趣的特定术后结果总体较低，不同技术之间的差异较小。
虽然机器人平台与较长的手术时间相关，但这些发现必须在学习曲线和使用指征（即使用机器人治疗技术上具有挑战性的病例）的背景下进行解释。我们的研究结果表明，在退伍军人事务部，机器人作为一种安全的普通外科手术平台，与传统方法一样安全。未来的研究应侧重于包括疼痛和美容在内的以患者为中心的结果。
