Department of Pediatric Surgery, Robert-Debré Children University Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
Paris-Cité University, Paris, France.
J Robot Surg. 2023 Oct;17(5):2287-2295. doi: 10.1007/s11701-023-01647-2. Epub 2023 Jun 19.
The aim of this study was to compare outcomes of laparoscopic and robotic-assisted colectomy in children. All children who underwent a colectomy with a laparoscopic (LapC) or robotic-assisted (RobC) approach in our institution (January 2010-March 2023) were included. Demographics, surgical data, and post-operative outcomes within 30 days were collected. Additional cost related to the robotic approach was calculated. Comparisons were performed using Fisher tests for categorical variables and Mann-Whitney tests for continuous variables. A total of 55 colectomies were performed: 31 LapC and 24 RobC (median age: 14.9 years). Main indications included: inflammatory bowel disease (n = 36, 65%), familial adenomatous polyposis (n = 6, 11%), sigmoid volvulus (n = 5, 9%), chronic intestinal pseudo-obstruction (n = 3, 5%). LapC included 22 right, 4 left, and 5 total colectomies. RobC included 15 right, 4 left, and 5 total colectomies. Robotic-assisted surgery was associated with increased operative time (3 h vs 2.5 h, p = 0.02), with a median increase in operative time of 36 min. There were no conversions. Post-operative complications occurred in 35% of LapC and 38% of RobC (p = 0.99). Complications requiring treatment under general anesthesia (Clavien-Dindo 3) occurred in similar rates (23% in LapC vs 13% in RobC, p = 0.49). Length of hospitalization was 10 days in LapC and 8.5 days in RobC (p = 0.39). The robotic approach was associated with a median additional cost of 2156€ per surgery. Robotic-assisted colectomy is as safe and feasible as laparoscopic colectomy in children, with similar complication rates but increased operative times and cost.
本研究旨在比较腹腔镜和机器人辅助结直肠切除术在儿童中的疗效。收集了我院 2010 年 1 月至 2023 年 3 月期间所有接受腹腔镜（LapC）或机器人辅助（RobC）结直肠切除术的患儿的临床资料。记录了患儿的人口统计学、手术数据和术后 30 天内的结果。计算了机器人辅助手术相关的额外费用。使用 Fisher 检验进行分类变量比较，Mann-Whitney 检验进行连续变量比较。共进行了 55 例结直肠切除术：31 例 LapC 和 24 例 RobC（中位年龄：14.9 岁）。主要适应证包括：炎症性肠病（n=36，65%）、家族性腺瘤性息肉病（n=6，11%）、乙状结肠扭转（n=5，9%）、慢性假性肠梗阻（n=3，5%）。LapC 包括 22 例右半结肠切除术、4 例左半结肠切除术和 5 例全结肠切除术。RobC 包括 15 例右半结肠切除术、4 例左半结肠切除术和 5 例全结肠切除术。机器人辅助手术的手术时间明显延长（3 小时比 2.5 小时，p=0.02），中位手术时间延长 36 分钟。没有中转开腹。LapC 和 RobC 的术后并发症发生率分别为 35%和 38%（p=0.99）。需要全身麻醉治疗的并发症（Clavien-Dindo 3 级）发生率相似（LapC 为 23%，RobC 为 13%，p=0.49）。LapC 的住院时间为 10 天，RobC 为 8.5 天（p=0.39）。机器人辅助手术的中位额外费用为每次手术 2156 欧元。机器人辅助结直肠切除术在儿童中与腹腔镜结直肠切除术一样安全可行，并发症发生率相似，但手术时间延长，费用增加。
