Liu Langfeier, Lewis Nicholas, Mhaskar Rahul, Sujka Joseph, DuCoin Christopher
University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Surg Endosc. 2023 Apr;37(4):2800-2805. doi: 10.1007/s00464-022-09814-6. Epub 2022 Dec 7.
Two of the most common foregut operations are laparoscopic Heller myotomy and laparoscopic Nissen fundoplication. Robotic assistance, compared to standard laparoscopic approach, may potentially grant surgeons advantages such as enhanced visualization and dexterity. This study compares patient outcomes for Heller myotomy (HM) and Nissen fundoplication (NF) when performed laparoscopically versus robotically.
A retrospective review of patients at a single institution who underwent laparoscopic or robotic-assisted HM or NF from January 2019 to July 2022 was conducted. 123 HM (72 laparoscopic, 51 robotic-assisted) and 92 NF (62 laparoscopic, 30 robotic-assisted) were performed by three surgeons. Outcomes investigated were operative time, hospital length of stay, pre- and post-operative imaging, resolution of symptoms at 30 days, resolution of symptoms at 90 days, and complications.
In the HM cohorts, the average operative time was longer in the robotic cohort (127 min robotic versus 108 min laparoscopic, p < 0.01). However, overall complication rates (p < 0.05) were lower, and hospital length of stay was shorter in the robotic group (1.5 days compared to 2.7 days, p < 0.001). In the NF cohorts, there was no significant difference in operative time. However, hospital length of stay was shorter in the robotic group (1.54 days compared to 2.7 days, p < 0.001) with otherwise similar outcomes. There was no difference in the rate of post-operative resolution of symptoms or need for additional interventions in either HM or NF.
Robotic-assisted HM and NF are associated with shorter hospital stays compared to their respective laparoscopic approaches. Robotic-assisted HM also has a lower rate of complications. Our findings suggest that robotic assistance may be beneficial for shortening hospital length of stay and decreasing complications for certain surgeries specific to Foregut surgery.
两种最常见的前肠手术是腹腔镜Heller肌切开术和腹腔镜Nissen胃底折叠术。与标准腹腔镜手术方法相比，机器人辅助手术可能会为外科医生带来诸如增强可视化和灵活性等优势。本研究比较了腹腔镜与机器人辅助下进行Heller肌切开术（HM）和Nissen胃底折叠术（NF）的患者结局。
对2019年1月至2022年7月在单一机构接受腹腔镜或机器人辅助HM或NF手术的患者进行回顾性研究。三位外科医生共实施了123例HM（72例腹腔镜手术，51例机器人辅助手术）和92例NF（62例腹腔镜手术，30例机器人辅助手术）。研究的结局指标包括手术时间、住院时间、术前和术后影像学检查、30天症状缓解情况、90天症状缓解情况以及并发症。
在HM队列中，机器人辅助组的平均手术时间更长（机器人辅助手术为127分钟，腹腔镜手术为108分钟，p<0.01）。然而，机器人辅助组的总体并发症发生率较低（p<0.05），住院时间也更短（分别为1.5天和2.7天，p<0.001）。在NF队列中，手术时间无显著差异。然而，机器人辅助组的住院时间更短（分别为1.54天和2.7天，p<0.001），其他结局相似。HM或NF术后症状缓解率或额外干预需求方面没有差异。
与各自的腹腔镜手术方法相比，机器人辅助HM和NF的住院时间更短。机器人辅助HM的并发症发生率也较低。我们的研究结果表明，机器人辅助可能有利于缩短特定前肠手术的住院时间并减少并发症。
