de Figueiredo Sergio Mazzola Poli, Tastaldi Luciano, Mao Rui-Min Diana, Phillips Sharon, Lu Richard
Division of General Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
Division of General Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
Am J Surg. 2023 Feb;225(2):383-387. doi: 10.1016/j.amjsurg.2022.09.008. Epub 2022 Sep 11.
Concomitant robotic-assisted laparoscopic prostatectomy (RALP) and robotic inguinal hernia repair (RIHR) has been reported. Nevertheless, data on its safety is lacking and some surgeons avoid performing both operations concurrently due to the potential risk of mesh related complications in the setting of a fresh vesicourethral anastomosis. We aimed to investigate differences in 30-day outcomes between patients undergoing RALP+RIHR and those undergoing RIHR alone.
Patients who have undergone concomitant RALP and RIHR with 30-day follow-up available were identified within the Abdominal Core Health Quality Collaborative. Using a propensity score algorithm, they were matched with a cohort of patients undergoing RIHR alone based on confounders such as body mass index, age, ASA class, smoking, hernia size and recurrent status and prior pelvic operation. The groups were compared for 30-day rates of surgical site infection (SSI), surgical site occurrences (SSO), surgical site occurrences requiring operative intervention (SSOPI) and hernia recurrence.
24 patients underwent RALP + RIHR and were matched to 72 patients who underwent RIHR alone (3:1). Median age was 64 years, 33% were obese and 17% smokers. No significant differences were found on 30-day rates of overall complications (21% RALP + RIHR vs. 15% RIHR, p = 0.53) and surgical site occurrences (12% RALP + RIHR vs.11% RIHR, p = 0.85). No patient in the RALP + RIHR group had a 30-day SSI, SSOPI or early recurrence.
RALP+RIHR appears not to result in increased rates of wound complications, overall complications or early recurrence when compared to patient undergoing RIHR alone. Prospective, controlled studies with larger number of patients are needed to confirm our findings.
已有报道称可同时进行机器人辅助腹腔镜前列腺切除术（RALP）和机器人腹股沟疝修补术（RIHR）。然而，关于其安全性的数据尚缺乏，并且由于在新的膀胱尿道吻合术中存在网片相关并发症的潜在风险，一些外科医生避免同时进行这两种手术。我们旨在研究接受RALP+RIHR的患者与仅接受RIHR的患者在30天结局方面的差异。
在腹部核心健康质量协作组中确定了接受RALP和RIHR且有30天随访数据的患者。使用倾向评分算法，根据体重指数、年龄、美国麻醉医师协会（ASA）分级、吸烟情况、疝大小、复发状态和既往盆腔手术等混杂因素，将他们与一组仅接受RIHR的患者进行匹配。比较两组的手术部位感染（SSI）、手术部位事件（SSO）、需要手术干预的手术部位事件（SSOPI）和疝复发的30天发生率。
24例患者接受了RALP+RIHR，并与72例仅接受RIHR的患者（3:1）进行了匹配。中位年龄为64岁，33%为肥胖患者，17%为吸烟者。在总体并发症的30天发生率（RALP+RIHR组为21%，RIHR组为15%，p=0.53）和手术部位事件（RALP+RIHR组为12%，RIHR组为11%，p=0.85）方面未发现显著差异。RALP+RIHR组中没有患者发生30天的SSI、SSOPI或早期复发。
与仅接受RIHR的患者相比，RALP+RIHR似乎不会导致伤口并发症、总体并发症或早期复发率增加。需要进行更多患者的前瞻性对照研究来证实我们的发现。
