Arnott Suzanne M, Arnautovic Alisa, Haviland Sarah, Ng Matthew, Obias Vincent
Department of Colorectal Surgery, George Washington University, Washington, D.C., USA.
Department of Surgery, George Washington University, 1438 Park Road, NW, Washington, D.C., 20010, USA.
J Robot Surg. 2023 Apr;17(2):587-595. doi: 10.1007/s11701-022-01452-3. Epub 2022 Sep 1.
Non-elective minimally invasive surgery (MIS) remains controversial, with minimal focus on robotics. This study aims to evaluate the short-term outcomes for non-elective robotic colectomies for diverticulitis. All colectomies for diverticulitis in ACS-NSQIP between 2012 and 2019 were identified by CPT and diagnosis codes. Open and elective cases were excluded. Patients with disseminated cancer, ascites, and ventilator-dependence were excluded. Procedures were grouped by approach (laparoscopic and robotic). Demographics, operative variables, and postoperative outcomes were compared between groups. Covariates with p < .1 were entered into multivariable logistic regression models for 30 day mortality, postoperative septic shock and reoperation. 6880 colectomies were evaluated (Laparoscopic = 6583, Robotic = 297). The laparoscopic group included more preoperative sepsis (31.6% vs. 10.8%), emergency cases (32.3% vs. 6.7%), and grade 3/4 wound classifications (53.3% vs. 42.8%). There was no difference in mortality, anastomotic leak, SSI, reoperation, readmission, or length of stay. The laparoscopic group had more postoperative sepsis (p = 0.001) and the robotic group showed increased bleeding (p = 0.011). In a multivariate regression model, increased age (OR = 1.083, p < 0.001), COPD (OR = 2.667, p = 0.007), dependent functional status (OR = 2.657, p = 0.021), dialysis (OR = 4.074, p = 0.016), preoperative transfusions (OR = 3.182, p = 0.019), emergency status (OR = 2.241, p = 0.010), higher ASA classification (OR = 3.170, p = 0.035), abnormal WBC (OR = 1.883, p = 0.046) were independent predictors for mortality. When controlling for confounders, robotic approach was not statistically significantly associated with septic shock or reoperation. When controlling for confounders, robotic approach was not a predictor for mortality, reoperation or septic shock. Robotic surgery is a feasible option for the acute management of diverticulitis.
非选择性微创手术（MIS）仍存在争议，对机器人手术的关注极少。本研究旨在评估因憩室炎进行的非选择性机器人结肠切除术的短期结局。通过现行程序编码（CPT）和诊断编码确定了2012年至2019年间美国外科医师学会国家外科质量改进计划（ACS-NSQIP）中所有因憩室炎进行的结肠切除术。排除开放手术和择期手术病例。排除有播散性癌症、腹水和依赖呼吸机的患者。手术按入路（腹腔镜和机器人手术）分组。比较两组之间的人口统计学、手术变量和术后结局。将p<0.1的协变量纳入多变量逻辑回归模型，以分析30天死亡率、术后感染性休克和再次手术情况。共评估了6880例结肠切除术（腹腔镜手术=6583例，机器人手术=297例）。腹腔镜组术前脓毒症更多（31.6%对10.8%）、急诊病例更多（32.3%对6.7%）以及伤口分级为3/4级的更多（53.3%对42.8%）。在死亡率、吻合口漏、手术部位感染、再次手术、再入院或住院时间方面无差异。腹腔镜组术后脓毒症更多（p=0.001），机器人手术组出血增加（p=0.011）。在多变量回归模型中，年龄增加（比值比[OR]=1.083，p<0.001）、慢性阻塞性肺疾病（COPD）（OR=2.667，p=0.007）、依赖性功能状态（OR=2.657，p=0.021）、透析（OR=4.074，p=0.016）、术前输血（OR=3.182，p=0.019）、急诊状态（OR=2.241，p=0.010）、较高的美国麻醉医师协会（ASA）分级（OR=3.170，p=0.035）、白细胞异常（OR=1.883，p=0.046）是死亡率的独立预测因素。在控制混杂因素后，机器人手术入路与感染性休克或再次手术无统计学显著关联。在控制混杂因素后，机器人手术入路不是死亡率、再次手术或感染性休克的预测因素。机器人手术是憩室炎急性治疗的一种可行选择。
